Sample Record for 2026-02-25-3

Project ID: 1001824 DEA: 061J3104 EFIS: 0626000064 QA Service Level: 1

DIST-CO-RTE-PM: 06-KER-204-5.9/5.9

Work Description: Calloway Canal bridge repair at Bridge No. 50 0209

Location Description: Replacement of existing barrier rail and sidewalk on WB direction, demo and reconstruct overhang, remove existing AC overlay (2-ft wide from curb), strengthen deck with carbon fiber reinforced polymer bar, place AC overlay, and install new barrier rail.

Contractor Name: Bugler Construction (Kevin Hoffert)

Contractor Address: 4847 Hopyard Rd, Suite 4 #395, Pleasanton, CA 94588

Resident Engineer: Vanessa Valdez Structure Rep.: Vicente Sanchez

DIME Sample ID: 2026-02-25-3

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: 02/25/2026

Date that the sample was received by the laboratory/organization performing the testing: 03/02/2026

The quantity of what the sample constitutes: 1 lot of 62

A brief description of the sample: Hex Headed threaded anchor rod

From where was the sample collected: Other

Laboratory sample identification:

Structure unique identifier: 50-0209

Structure name: Calloway Canal Bridge

The fabricator/manufacturer/facility name: C & K Johnson Ind.

Rocap Number(s): N/A

Heat Number(s): 256785 8000037449 148668

Nut Mfg. Lot Number(s): W000296713

Washer Mfg. Lot Number(s): 148668

Bolt Specification: ASTM F1554, Grade 105

Bolt Length(s): 17-1/2"

Nut Specification: ASTM F563, Grade DH

Washer Specification: ASTM F436

Finish: ASTM A153/F2329 - Hot Dip

Diameter/Size: 1-1/4"

Bolt Mfg. Lot Number: 191442-001

Rocap Test Requirement(s): None

Lubricant Requirements(s): none

Washer Inner Diameter(s): NA