Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2022-03-15-1
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 214337 DEA: 080E33U4 EFIS: 0817000075 |
|---|---|
| DIST-CO-RTE-PM | 08-SBD-115-R7.3/R10.0 |
| Award Date | 04/26/2021 |
| Closeout Date | Not set |
| Work Description | ADD WB AUX & EB DECEL LANES, WIDEN I15 SW CONNECT,RAMPS/BRDG |
| Location Description | SAN BERNARDINO COUNTY IN ONTARIO FROM 0.2 MILE WEST OF CUCAMONGA CREEK BRIDGE TO MILLIKEN AVENUE |
| QA Service Level | 1 (Verified on 06/23/2021) |
Sample Information
| Sample Taken Date | 03/15/2022 | 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 | 03/15/2022 |
| Sample type | Quality Assurance | A brief description of the sample | 2-1/2 Anchor bolt |
| The quantity of what the sample constitutes | 3 anchor bolts | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Lorenzo | Last name of sampler or witnessed by | Garcia |
| Title of sampler | Telephone number of sampler | 17029172503 | |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Madden Bolt | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | L115-023-22 | Structure unique identifier | |
| Structure name |
Material Information
| Material Type | SMTL TM5 - Threaded Bar | Production or Authorization Testing | Production Testing |
|---|---|---|---|
| Threaded Bar Specification | ASTM A529 | Threaded Bar Grade | 55 |
| Threaded Bar Type | Plain | Rebar Size | |
| Nut Specification for Threaded Bar | A563 | System Manufacturer | Dyson |
| Epoxy Coating Color | NA | Threaded Bar Application | Threaded Bar |
| Coating Standards | ASTM A153 galvanized | Bar Heat Number(s) | 58050393 |
| Nut Heat Number(s) | 20734310 | Bar Lot Number | |
| Nut Lot Number | Coupler Heat Number(s) | ||
| Coupler Grade |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||