Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213099 DEA: 041A6614 EFIS: 0415000291 COOP: 042683A1
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-8.4
Work Description: CONSTRUCTION ON STATE HIGHWAY IN MARIN COUNTY IN LARKSPUR
Location Description:
Contractor Name: Disney Construction
Contractor Address: 533 airport Blvd, Suite 120, Burlingame, CA 94010
Resident Engineer: Steven Russell Structure Rep.: Long Ly
DIME Sample ID: 2021-09-13-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Verification
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 09/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/01/2021
The quantity of what the sample constitutes: 2
A brief description of the sample: ASTM A108 150 KSI Hex Nuts
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Engineering-SD
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A722
Threaded Bar Grade: 150
Threaded Bar Type:
Rebar Size:
Nut Specification for Threaded Bar: ASTM A108
System Manufacturer: Williams Form Engineering San Diego
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: ASTM A123 galvanized
Bar Heat Number(s):
Nut Heat Number(s): 8298464
Bar Lot Number:
Nut Lot Number: 26E5D
Coupler Heat Number(s):
Coupler Grade:
DIME Test ID: 2021-09-13-2-1
Test Method: ASTM A722-15: Standard Specification for High-Strength Steel Bars for Prestressed Concrete (Tensile)
Verified Date: 10/05/2021
Date Tested: 10/05/2021
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: Nut Test only
Test Result Compliance:
Additional Comments When Verified:
|
Number of Threaded Bar Samples
|
1
|
| Sample | Size | Mfg Lot | Area (sqin) | Tensile Strength (psi) | Stress at Offset (psi) | Total Elongation (%) | Reduction of area (%) | Comments | Tested By | | 1 | ASTM A722 Type I Plain Bar 1 : | NUT Heat 8298464 26E5D | 0.85 | 166019.35 | 136.45 | 0 | 100 | Nut Test only | fsaylor |
| |
|
Temperature
|
72 f
|
|
UTM
|
400kip
|
DIME Test ID: 2021-09-13-2-2
Test Method: ASTM A722-15: Standard Specification for High-Strength Steel Bars for Prestressed Concrete (Tensile)
Verified Date: 10/05/2021
Date Tested: 10/05/2021
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: Nut Test only
Test Result Compliance:
Additional Comments When Verified:
|
Number of Threaded Bar Samples
|
1
|
| Sample | Size | Mfg Lot | Area (sqin) | Tensile Strength (psi) | Stress at Offset (psi) | Total Elongation (%) | Reduction of area (%) | Comments | Tested By | | 1 | ASTM A722 Type II Deformed Bar 1 : 26mm | NUT Heat 8298464 26E5D | 0.85 | 164664.17 | 137.43 | 0 | 100 | Nut Test only | fsaylor |
| |
|
Temperature
|
72 f
|
|
UTM
|
400kip
|
