Sample Record for 2026-03-30-21
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000785 DEA: 081J3204 EFIS: 0818000017 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-17.8
Work Description: BUILDING WORK, WROUGHT IRON FENCE, HOT MIX ASPHALT, & AGGREGATE BASE.
Location Description: RIVERSIDE COUNTY NEAR LAKE ELSINORE AT LAKE ELSINORE MAINTENANCE STATION AT 18745 CONARD AVENUE
Contractor Name: NATIONWIDE CONTRACTING SERVICES, INC. DBA NATIONWIDE GENERAL CONSTRUCTION SERVICES
Contractor Address: 7660 liberty drive, Huntington beach, CA, 92647
Resident Engineer: Jason Shbaita Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-03-30-21
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: 03/30/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 10 pcs
A brief description of the sample: 5/8” x 5” ASTM F1554 GR36 Galv. DH Heavy Hex Nut ASTM A563 Flat washer ASTM F436
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name: Building Work
The fabricator/manufacturer/facility name: AB Threading inc.
Material Information
Rocap Number(s): NA, Anchor Bolts
Heat Number(s): Anchor Bolts
Nut Mfg. Lot Number(s): W000278671
Washer Mfg. Lot Number(s): 12511080
Bolt Specification: ASTM F1554
Bolt Length(s): 5"
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: NA
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: 1000221652
Rocap Test Requirement(s): Anchor Bolts
Lubricant Requirements(s): Anchor Bolts Nut green wax
Washer Inner Diameter(s): NA
Test Results
