Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2021-12-06-3

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 Date12/06/2021 Sample Unique Key3
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 sample#8 HRC 120 X 13'-2"
The quantity of what the sample constitutes4 of 16 From where was the sample collectedFabricator
First name of sampler or witnessed byHitesh Last name of sampler or witnessed byPatel
Title of samplerQuality Assurance Inspector Telephone number of sampler9168691602
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) FormL131-049-21 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Headed Bars Production or Authorization TestingProduction Testing
Rebar Heat Number(s)4112178 Head Manufacturer Lot Number(s)LOT 1
Rebar Size#8 Headed Bar Model NameHRC 120
Size of HeadFull Size - 9x Head Connection TypeFriction Weld
Head ShapeSquare Rebar ManufacturerCMC Rebar
Head ManufacturerNUCOR HEAT No 10010900121 Head FabricatorHRC
Material Standard CodeASTM A706 Headed Bar Unique IDNot set

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