Sample Record for 2026-04-16-4
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: 2026-04-16-4
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: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 04/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/21/2026
The quantity of what the sample constitutes: 10
A brief description of the sample: .5"x6" A325 Bolts .5" A563 Nuts .5" F436 Washers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CraneVeyor Corp
Material Information
Rocap Number(s): N/A
Heat Number(s): Bolts 10889460
Nuts 1000124630
Wahers 190156535
Nut Mfg. Lot Number(s): W000165726
Washer Mfg. Lot Number(s): 100012463020
Bolt Specification: A325-1
Bolt Length(s): 6"
Nut Specification: A563
Washer Specification: F436
Finish: Galvanized
Diameter/Size: 1/2"
Bolt Mfg. Lot Number: 071024-1BR
Rocap Test Requirement(s): No
Lubricant Requirements(s): No
Washer Inner Diameter(s): half inch
Test Results
