Sample Record for 2025-09-17-17
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994828 DEA: 043Y4104 EFIS: 0423000232
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC,SM-680-25.04/25.46, VAR/VAR
Work Description: Paint removal and non-destructive testing (NDT) on butt weld connections on T1 type steel in fracture critical members of three distinct existing toll bridge.
Location Description: Carquinez Bridge Overhead (Br. No. 23-0015R), Benicia-Martinez Bridge Overhead (Br. No. 28-0153L), and San Mateo-Hayward Bridge (Br. No. 35-0054). County = SM,CC,SOL. Route = 680,80,92.
Contractor Name: Golden State Bridge Inc.
Contractor Address: Unknown
Resident Engineer: Kingston Atako Structure Rep.: Angelo Perez
Sample Information
DIME Sample ID: 2025-09-17-17
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Acceptance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/17/2025
The quantity of what the sample constitutes: TBD30
A brief description of the sample: 7/8 - 9 5-1/2" ASTM F3125 GR A490 Bolt
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bay Bolt
Material Information
Rocap Number(s): 3511-11
Heat Number(s): Bolt 10019510
Nut 8000029551
Washer 42329370
Nut Mfg. Lot Number(s): W000149410
Washer Mfg. Lot Number(s): 181439
Bolt Specification: ASTM F3125 GR A490
Bolt Length(s): 5.5"
Nut Specification: ASTM A194
Washer Specification: ASTM F436
Finish: Plain
Diameter/Size: 7/8 - 9
Bolt Mfg. Lot Number: 636666
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test Results
