Sample Record for 2026-01-09-9
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215365 DEA: 120Q9704 EFIS: 1218000010
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405-0/11.4
Work Description: I-405 improvement project from I-5 to Harbor Boulevard including extend pavement life, improve safety, enhance traffic operation, and incorporate Intelligent Transportation Systems (ITS).
Location Description: Orange County I-405 PM 0 - 11.4
Contractor Name: Guy F. Atkinson
Contractor Address: 38 Executive Park, IRVINE CA 92614
Resident Engineer: Mona Shahidi Structure Rep.: Brian Vo
Sample Information
DIME Sample ID: 2026-01-09-9
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 TM3 - Fastener Assembly
Sample Taken Date: 01/09/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 18 pcs.
A brief description of the sample: 1-1/8(7)X 4-1/2 A325-1 BOLT HDG
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: St.Louis Screw and Bolt
Material Information
Rocap Number(s): TT0197005
Heat Number(s): Bolt-BG2661, Nut-41116-245349, Wash-46546-240176
Nut Mfg. Lot Number(s): Nut-41116-245349
Washer Mfg. Lot Number(s): Wash-46546-240176
Bolt Specification: ASTM A325
Bolt Length(s): 4 1/2"
Nut Specification: ASTM A563
Washer Specification: ASTM F436-1
Finish: ASTM A153, ASTM F2329
Diameter/Size: 1 1/8"
Bolt Mfg. Lot Number: Bolt-BG2661
Rocap Test Requirement(s): Max. Torque
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test Results
