Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994673 DEA: 033F0704 EFIS: 0312000054
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-2.0/3.5
Work Description: American River Bridge Rehabilitation
Location Description:
Contractor Name: American River Constructors
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: John Ruzic Structure Rep.: Pha Tran
DIME Sample ID: 2024-10-04-60
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 10/04/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/08/2024
The quantity of what the sample constitutes: 2400
A brief description of the sample: ASTM F3125 Grade A325 7/8-j9 x 2 1/4 Tension Control Assembly
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bay Bolt Oakland, Ca
Rocap Number(s): 40585-1000124897
Heat Number(s):
Nut Mfg. Lot Number(s): 40670-5806096204
Washer Mfg. Lot Number(s): 0424-208
Bolt Specification: ASTM F3125
Bolt Length(s):
Nut Specification: ASTM F3125
Washer Specification: ASTM F3125
Finish: Mech Galv
Diameter/Size: 7/8
Bolt Mfg. Lot Number: 40585-1000124897
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
