Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2021-10-05-1
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Project Information
| Project Identifiers | Project ID: 215220 DEA: 07210624 EFIS: 0719000068 |
|---|---|
| DIST-CO-RTE-PM | 07-LA,SBD-71-1.8/R4.7&R0.0/R0.2 |
| Award Date | 02/05/2021 |
| Closeout Date | Not set |
| Work Description | PLACE STRUCTURE CONCRETE RETAINING WALLS & BOX CULVERT AND PLACE JPCP. |
| Location Description | IN LOS ANGELES AND SAN BERNARDINO COUNTIES IN POMONA AND CHINO HILLS FROM 0.2 MILE SOUTH OF MISSION BOULEVARD OVERCROSSING TO 0.2 MILE OF SAN BERNARDINO COUNTY LINE. |
| QA Service Level | 1 (Verified on 03/24/2021) |
Sample Information
| Sample Taken Date | 10/05/2021 | Sample Unique Key | 1 |
|---|---|---|---|
| Will the laboratory/organization for which you are a member perform testing on this material sample? | Yes | Date that the sample was received by the laboratory/organization performing the testing | 10/12/2021 |
| Sample type | Quality Assurance | A brief description of the sample | #8 ASTM A615 Grade 75 Bar |
| The quantity of what the sample constitutes | 2 | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | Arthur | Last name of sampler or witnessed by | Peterson |
| Title of sampler | Telephone number of sampler | 7073428602 | |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Williams Form Engineering - CO | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | L110-137-21 | Structure unique identifier | |
| Structure name |
Material Information
| Material Type | SMTL TM5 - Threaded Bar | Production or Authorization Testing | Authorization Testing |
|---|---|---|---|
| Threaded Bar Specification | ASTM A615 | Threaded Bar Grade | 75 |
| Threaded Bar Type | Plain | Rebar Size | #8 |
| Nut Specification for Threaded Bar | ASTM A108/A29/A576 | System Manufacturer | Williams Form Engineering CO |
| Epoxy Coating Color | NA | Threaded Bar Application | Soil Nail |
| Coating Standards | Uncoated | Bar Heat Number(s) | 100110776 |
| Nut Heat Number(s) | 5392774 | Bar Lot Number | 10011077620 |
| Nut Lot Number | 8V1D | Coupler Heat Number(s) | NA |
| Coupler Grade | NA |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2021-10-05-1-1 ASTM A615-15 (Verified)
DIME Test ID: 2021-10-05-1-2 ASTM A615-15 (Verified)