Sample Record

Owner Lab

  • CT QASI - Sacramento Field Laboratory

DIME Sample ID 2021-07-01-4

Project Information

Project IdentifiersProject ID: 215424
DEA: 024G4404
EFIS: 0214000013
DIST-CO-RTE-PM02-SIS-3-38.0/38.6
Award Date03/22/2021
Closeout DateNot set
Work DescriptionBRIDGE REPLACEMENT
Location DescriptionSISKIYOU COUNTY ABOUT 6 MILES NORTH OF FORT JONES FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF LOWER MOFFETT CREEK ROAD
QA Service Level1 (Verified on 01/19/2021)

Sample Information

Sample Taken Date07/01/2021 Sample Unique Key4
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testingNot set
Sample typeQuality Assurance A brief description of the sample#5 epoxy coated formsaver couplers
The quantity of what the sample constitutes2 lots for 250 total From where was the sample collectedFabricator
First name of sampler or witnessed byJane Last name of sampler or witnessed byLillard
Title of samplerCALTRANS QA INSPECTOR Telephone number of sampler916-291-8042
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameCon-Fab California, LLC Transportation Laboratory (TL) Number926652
Inspector Lot Number from the Transportation Laboratory (TL) FormS52-028-21 Structure unique identifier
Structure nameExterior girders M1, M3

Material Information

Material TypeSMTL TM7 - Epoxy Coated Rebar Rebar Heat Number(s)3600019380
Rebar Epoxy Batch Number(s)3CH2101005 Rebar Coating SpecificationASTM A775
Rebar Size (#)5 Rebar Coating ColorGreen
Rebar ManufacturerNUCOR Rebar CoaterMidwest Pipe Coating Inc
Rebar Powder ManufacturerValspar Release Number
Quality Assurance Code

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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