Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995026 DEA: 040Q1004 EFIS: 0418000044
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-20.7/30.8
Work Description: REHAB ALA 580
Location Description: ALAMEDA COUNTY IN PLEASANTON AND CASTRO VALLEY FROM ROUTE 680/580 SEPARATION TO ROUTE 580/238 SEPARATION
Contractor Name: FBD VANGUARD CONSTRUCTION, INC.
Contractor Address: 550 Greenville Road, Livermore, CA 94550
Resident Engineer: Paramjit Pandher Structure Rep.: John Parecadan
DIME Sample ID: 2026-03-11-85
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (213) 505-4213
Type of Sample: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 03/11/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/20/2026
The quantity of what the sample constitutes: 585
A brief description of the sample: 2" A563 Gr. DH Heavy Hex Nut
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales
Rocap Number(s): N/A
Heat Number(s): 21007700
Nut Mfg. Lot Number(s): BZRB
Washer Mfg. Lot Number(s): N/A
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: A563
Washer Specification: N/A
Finish: HDG w/ Wax & Dye
Diameter/Size: 2"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): 0
Lubricant Requirements(s): 0
Washer Inner Diameter(s): 0
