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Sample Record for 2021-05-21-9

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Project Information

Project ID: 214579 DEA: 010B0904 EFIS: 0100020444 QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-8.2/8.7
Work Description: Panther Creek & Hunter Creek Bridges
Location Description: DEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Ryan Dunne Structure Rep.: Brian Cinkutis

Sample Information

DIME Sample ID: 2021-05-21-9
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 05/21/2021
Date that the sample was received by the laboratory/organization performing the testing: 05/21/2021
The quantity of what the sample constitutes: 66
A brief description of the sample: Superior D101 Form Savers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: PJs Rebar

Material Information

Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Nucor
Coupler Manufacturer: Superior D101 Form Savers
Intermediate Assembler or Fabricator: PJs Rebar
Rebar Size: #10
Coupler Model: Superior D101 Form Savers
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): x
Rebar Heat Number(s): 3500001289
Rebar Size 2 : 10
Coupler Unique ID:

Test Results

Test 1 of 3

DIME Test ID: 2021-05-21-9-1
Test Method: CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Cyclical/Fatique Tensile with Slip)
Verified Date: 05/26/2021
Date Tested: 05/25/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test: Ok necking
Test Result Compliance:
Additional Comments When Verified:
Number of Samples Tested 1
SampleNumber of CyclesSizeMfg. Lot Number(s)Slip (inch)Area (sqin)Peak Load (lbf)Peak Stress (psi)CommentsTested By
1No. 10/32mm1-0.00551.2712321397018Ok neckingbewing
UTM 2000kip
Temperature 72.00 f
Halo ID Small

Test 2 of 3

DIME Test ID: 2021-05-21-9-2
Test Method: CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Cyclical/Fatique Tensile with Slip)
Verified Date: 05/26/2021
Date Tested: 05/25/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test: Ok necking
Test Result Compliance:
Additional Comments When Verified:
Number of Samples Tested 1
SampleNumber of CyclesSizeMfg. Lot Number(s)Slip (inch)Area (sqin)Peak Load (lbf)Peak Stress (psi)CommentsTested By
2No. 10/32mm101.2712314696965Ok neckingbewing
UTM 2000kip
Temperature 72.00 f
Halo ID

Test 3 of 3

DIME Test ID: 2021-05-21-9-3
Test Method: CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Cyclical/Fatique Tensile with Slip)
Verified Date: 05/26/2021
Date Tested: 05/25/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test: Ok necking
Test Result Compliance:
Additional Comments When Verified:
Number of Samples Tested 1
SampleNumber of CyclesSizeMfg. Lot Number(s)Slip (inch)Area (sqin)Peak Load (lbf)Peak Stress (psi)CommentsTested By
3No. 10/32mm101.2712331397097Ok neckingbewing
UTM 2000kip
Temperature 72.00 f
Halo ID