Sample Record
Owner Lab
- CT HQ - QASI Sacramento Field Office
DIME Sample ID 2021-07-01-4
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 215424 DEA: 024G4404 EFIS: 0214000013 |
|---|---|
| DIST-CO-RTE-PM | 02-SIS-3-38.0/38.6 |
| Award Date | 04/05/2021 |
| Closeout Date | 08/14/2023 |
| Work Description | BRIDGE REPLACEMENT |
| Location Description | SISKIYOU 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 Level | 1 (Verified on 01/19/2021) |
Sample Information
| Sample Taken Date | 07/01/2021 | Sample Unique Key | 4 |
|---|---|---|---|
| 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 testing | Not set |
| Sample type | Quality Assurance | A brief description of the sample | #5 epoxy coated formsaver couplers |
| The quantity of what the sample constitutes | 2 lots for 250 total | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | Jane | Last name of sampler or witnessed by | Lillard |
| Title of sampler | CALTRANS QA INSPECTOR | Telephone number of sampler | 916-291-8042 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Con-Fab California, LLC | Transportation Laboratory (TL) Number | 926652 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | S52-028-21 | Structure unique identifier | |
| Structure name | Exterior girders M1, M3 |
Material Information
| Material Type | SMTL TM7 - Epoxy Coated Rebar | Rebar Heat Number(s) | 3600019380 |
|---|---|---|---|
| Rebar Epoxy Batch Number(s) | 3CH2101005 | Rebar Coating Specification | ASTM A775 |
| Rebar Size (#) | 5 | Rebar Coating Color | Green |
| Rebar Manufacturer | NUCOR | Rebar Coater | Midwest Pipe Coating Inc |
| Rebar Powder Manufacturer | Valspar | Release Number | |
| Quality Assurance Code |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||