Sample Record for 2024-10-07-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995448 DEA: 07316804 EFIS: 0715000220
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10S-28.3
Work Description: REPLACE BRIDGE DECK.
Location Description: LOS ANGELES COUNTY IN EL MONTE AT RIO HONDO BUSWAY BRIDGE
Contractor Name: POWELL CONSTRUCTORS, INC.
Contractor Address: 8555 Banana ave., Fontana Ca 92335
Resident Engineer: Jacky Chan Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2024-10-07-2
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 TM3 - Fastener Assembly
Sample Taken Date: 10/07/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 240
A brief description of the sample: anchor bolt assembly
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Powell Construction
Material Information
Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s): E804K1
Washer Mfg. Lot Number(s): 218553
Bolt Specification: ASTM F1554 Grade 105
Bolt Length(s): 16.5"
Nut Specification: ASTM A563-DH
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 1"
Bolt Mfg. Lot Number: 71251-1
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test Results
