Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2021-11-30-2

Project Information

Project IdentifiersProject ID: 215255
DEA: 040A7714
EFIS: 0420000287
DIST-CO-RTE-PM04-ALA-80-6.4-6.6
Award Date05/03/2021
Closeout DateNot set
Work DescriptionCONSTRUCT PEDESTRIAN OVERCROSSING BRIDGE AND RETAINING WALLS. GILMAN INTERCHANGE IMPROVEMENTS
Location DescriptionALAMEDA COUNTY IN BERKELEY FROM 0.6 MILE NORTH OF UNIVERSITY AVENUE OVERCROSSING TO 0.1 MILE SOUTH OF GILMAN STREET UNDERCROSSING
QA Service Level1 (Verified on 12/07/2020)

Sample Information

Sample Taken Date11/30/2021 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 testing12/07/2021
Sample typeQuality Control A brief description of the sample(4) #5 HRC 120 X 18'-0"
The quantity of what the sample constitutes(11) #5 HRC 120 X 18'-0" From where was the sample collectedFabricator
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 nameHRC Fountain Valley Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL133-127-21 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Headed Bars Production or Authorization TestingProduction Testing
Rebar Heat Number(s)4111735 Head Manufacturer Lot Number(s)LOT 1
Rebar Size#5 Headed Bar Model NameHRC 120 9FW 17 03
Size of HeadFull Size - 9x Head Connection TypeFriction Weld
Head ShapeSquare Rebar ManufacturerCMC Rebar
Head ManufacturerNUCOR HRC HEAT NO 10021114224 Head FabricatorHRC
Material Standard CodeASTM A706 Headed Bar Unique IDNot set

Submitted Tests

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