Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2021-07-12-1

Project Information

Project IdentifiersProject ID: 213099
DEA: 041A6614
EFIS: 0415000291
COOP: 042683A1
DIST-CO-RTE-PM04-MRN-101-8.4
Award Date11/30/2020
Closeout Date12/12/2023
Work DescriptionCONSTRUCTION ON STATE HIGHWAY IN MARIN COUNTY IN LARKSPUR
Location DescriptionNot set
QA Service Level1 (Verified on 11/06/2020)

Sample Information

Sample Taken Date07/12/2021 Sample Unique Key1
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 sampleHS Threaded Bar
The quantity of what the sample constitutesHeat 62150104 From where was the sample collectedManufacturer
First name of sampler or witnessed byDavid Last name of sampler or witnessed byWeeks
Title of samplerASI Telephone number of sampler310-883-8369
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameWilliams Form Engineering San Diego Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL79-033-21 Structure unique identifier27-0008Z
Structure name

Material Information

Material TypeSMTL TM5 - Threaded Bar Production or Authorization TestingProduction Testing
Threaded Bar SpecificationASTM A722 Threaded Bar Grade02
Threaded Bar TypePlain Rebar Size#8
Nut Specification for Threaded BarA108 System ManufacturerWilliams Form Engineering
Epoxy Coating ColorNA Threaded Bar ApplicationThreaded Bar
Coating StandardsUncoated Bar Heat Number(s)62150104
Nut Heat Number(s)8298147 Bar Lot NumberNA
Nut Lot Number26E3D Coupler Heat Number(s)NA
Coupler GradeNA

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments