Project Information

Project ID: 215063 DEA: 032F5704 EFIS: 0300020615 QA Service Level: 1

DIST-CO-RTE-PM: 03-PLA-80-46.3/63.5

Work Description: Replace 4 Bridges (OC) on Highway 80 from Crystal Springs to Cisco Grove (Baxter, Drum Forebay)

Location Description:

Contractor Name: Walsh Construction Company II, LLC (Walsh)

Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520

Resident Engineer: Tad Sampson Structure Rep.: Jimmer Ross

Sample Information

DIME Sample ID: 2021-11-09-5

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 TM7 - Epoxy Coated Rebar

Sample Taken Date: 11/09/2021

Date that the sample was received by the laboratory/organization performing the testing: 11/12/2021

The quantity of what the sample constitutes: 2

A brief description of the sample: #6x30 fully epoxy coated loose tie bars

From where was the sample collected: Source

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: American Highway

Material Information

Rebar Heat Number(s): 1202036445

Rebar Epoxy Batch Number(s): 3CH2041027

Rebar Coating Specification: ASTM A934

Rebar Size (#): 6

Rebar Coating Color: Purple

Rebar Manufacturer: Nucor

Rebar Coater: American Highway

Rebar Powder Manufacturer: Sherwin Williams

Release Number:

Quality Assurance Code:

Test Results

Test 1 of 2

DIME Test ID: 2021-11-09-5-1

Test Method: ASTM A934-13: Standard Specification for Epoxy-Coated Prefabricated Steel Reinforcing Bars (Holiday Bend)

Verified Date: 11/17/2021

Date Tested: 11/16/2021

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:

Test Result Compliance:

Additional Comments When Verified:

Total Number of Holiday	0
Total Length	5
Holidays Per Linear Foot of Bar	0
Holiday Test Pass/Fail	Pass
Bend Test Pass/Fail	Pass

Test 2 of 2

DIME Test ID: 2021-11-09-5-2

Test Method: ASTM A934-13: Standard Specification for Epoxy-Coated Prefabricated Steel Reinforcing Bars (Epoxy-Coating)