Sample Record

Owner Lab

  • CT QASI - Los Angeles Field Laboratory

DIME Sample ID 2021-09-22-2

Project Information

Project IdentifiersProject ID: 215164
DEA: 07317304
EFIS: 0715000237
DIST-CO-RTE-PM07-LA-60-0.0/R3.2,11.8/R21.5
Award DateNot set
Closeout DateNot set
Work DescriptionUPGRADE EXISTING OVERHEAD AND ROADSIDE SIGN PANELS.
Location DescriptionLOS ANGELS COUNTY FROM 0.4 MILE WEST OF ROUTE 5/60 SEPARATION TO ROUTE 60/710 SEPARATION AND FROM ROUTE 60/605 SEPARATION TO FAIRWAY DRIVE UNDERCROSSING
QA Service Level1 (Verified on 02/18/2021)

Sample Information

Sample Taken Date09/22/2021 Sample Unique Key2
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 Control A brief description of the samplePrequalification
The quantity of what the sample constitutes(4) #14Double Row ZAP Screwlok Type 2 Series From where was the sample collectedManufacturer
First name of sampler or witnessed byRigoberto Last name of sampler or witnessed byMarin
Title of sampler Telephone number of sampler9515000685
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameCamblin Steel Service Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL133-112-21 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Couplers Production or Authorization TestingAuthorization Testing
Service or UltimateUltimate Material Standard CodeASTM A706
Material Grade60 Rebar ManufacturerCMC Steel California
Coupler ManufacturerDouble Row ZAP Screwlok Type 2 Series Intermediate Assembler or Fabricator
Rebar Size#14 Coupler ModelSL-17-04
Coating StandardsUncoated Shape of RebarStraight
Rebar Hoop Diameter Rebar Hoop Fabricator
Coupler Component Heat/Lot Number(s)MM20106095 Rebar Heat Number(s)1065673
Rebar Size 2 11

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.