Sample Record for 2026-01-29-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000611 DEA: 120R32U4 EFIS: 1222000054
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-55-0.2/R17.8
Work Description: COLD PLANE, PLACE RHMA, REPLACE CB, SIGNS AND MODIFY LIGHTING SYSTEM.
Location Description: ORANGE COUNTY FROM 0.1 MILE SOUTH OF ROUTE 55/1 SEPARATION IN NEWPORT BEACH TO ROUTE 55/91 SEPARATION IN ANAHEIM
Contractor Name: R.J. NOBLE COMPANY
Contractor Address: 15505 East Lincoln Avenue, Orange, CA 92865
Resident Engineer: Tyrone Taylor Structure Rep.: Matthew Chang
Sample Information
DIME Sample ID: 2026-01-29-1
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: Per Request
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 01/29/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/04/2026
The quantity of what the sample constitutes: 276
A brief description of the sample: 3" Anchor Bolt Assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo Structural Products
Material Information
Rocap Number(s):
Heat Number(s): 79018795
Nut Mfg. Lot Number(s): BRAX
Washer Mfg. Lot Number(s): GERDAU
Bolt Specification: ASTM F1554 Gr 55 S-1
Bolt Length(s): 75.5
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 3"
Bolt Mfg. Lot Number: GERDAU
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test Results
