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Testing Report for 2021-08-12-3-2

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

DEA: 081C8504
EFIS: 0813000047
Project ID: 215109
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-0.0/5.8
Work Description: ROADWAY EXCAVATION, HOT MIX ASPHALT, AND STRUCTURAL SHOTCRETE WALLS.
Location Description: RIVERSIDE COUNTY NEAR LAKE ELSINORE FROM ORANGE COUNTY LINE TO MONTE VISTA STREET
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Osama Abdalla
Structure Rep.: Luis Negrete

Sample Information

DIME Sample ID: 2021-08-12-3
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 8/12/2021
Date that the sample was received by the laboratory/organization performing the testing: 8/19/2021
The quantity of what the sample constitutes: 2
A brief description of the sample: ASTM A722 HS All Thread Bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Engineering Golden, CO

Material Information

Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A722
Threaded Bar Grade: 150
Threaded Bar Type: Plain
Rebar Size: #11
Nut Specification for Threaded Bar: NA
System Manufacturer: Gerdau
Epoxy Coating Color: Purple
Threaded Bar Application: Threaded Bar
Coating Standards: ASTM A934 epoxy
Bar Heat Number(s): 58046951
Nut Heat Number(s): NA
Bar Lot Number: NA
Nut Lot Number: NA
Coupler Heat Number(s): NA
Coupler Grade: NA

Test Information

DIME Test ID: 2021-08-12-3-2
Test Method: ASTM A884-13: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Holiday)
Date Tested: 8/19/2021
Verified Date: 8/20/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: paul.lukkarila@dot.ca.gov
Organization Phone: (916) 227-7253
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified :

Submitted Test Results

Total Number of Holiday: no data
Total Length: 14
Holidays Per Linear Foot of Bar: no data
Holiday Test Pass/Fail: Pass