Sample Record

Owner Lab

  • CT HQ - QASI Sacramento Field Office

DIME Sample ID 2023-02-13-17

Project Information

Project IdentifiersProject ID: 993279
DEA: 010E0904
EFIS: 0113000123
DIST-CO-RTE-PM01-MEN-20-33.3/34.4
Award Date05/06/2022
Closeout DateNot set
Work DescriptionCONSTRUCT NEW BRIDGE, REMOVE TWO BRIDGES, EARTHWORK AND PAVING. (Bridge No. 10-0310)
Location DescriptionMENDOCINO COUNTY NEAR UKIAH FROM 0.3 MILE WEST OF RUSSIAN RIVER BRIDGE AND OVERHEAD TO 0.3 MILE EAST OF COUNTY ROAD 144
QA Service Level1 (Verified on 10/04/2021)

Sample Information

Sample Taken Date02/13/2023 Sample Unique Key17
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 testing02/13/2023
Sample typeQuality Assurance A brief description of the sample#9 Headed Reinforcement
The quantity of what the sample constitutes42 From where was the sample collectedFabricator
First name of sampler or witnessed byDuben Last name of sampler or witnessed byDuckworth
Title of samplerQA Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameCMC Rebar Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Headed Bars Production or Authorization TestingProduction Testing
Rebar Heat Number(s)4124602 Head Manufacturer Lot Number(s)2
Rebar Size#9 Headed Bar Model Name555
Size of HeadReduced Size - 4x Head Connection TypeForged
Head ShapeCircular Rebar ManufacturerCMC Rebar
Head ManufacturerCMC Rebar Head FabricatorCMC Rebar
Material Standard CodeASTM A706 Headed Bar Unique ID4FG-17-01

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