Sample Record for 2026-04-01-68

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 1000365 DEA: 033H9014 EFIS: 0323000075 QA Service Level: 1

DIST-CO-RTE-PM: 03-SOL,YOL-50,80,113-Var

Work Description: HMA, RHMA, SIGN STRUCTURE, CAMERA SYSTEMS, & FO CABLE SYSTEMS.

Location Description: SOLANO AND YOLO COUNTIES AT VARIOUS LOCATIONS

Contractor Name: DESILVA GATES CONSTRUCTION, LLC

Contractor Address: 3855 North Freeway Boulevard, Suite 100, Sacramento, CA 95834

Resident Engineer: Mirak Mehari Structure Rep.: Michael Charak

DIME Sample ID: 2026-04-01-68

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: Quality Assurance

Type of Material: SMTL TM3 - Fastener Assembly

Sample Taken Date: 04/01/2026

Date that the sample was received by the laboratory/organization performing the testing: 04/01/2026

The quantity of what the sample constitutes: 810

A brief description of the sample: A563-DH Hvy Hex Nuts

From where was the sample collected: Manufacturer

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Universal Industrial Sales

Rocap Number(s): N/A

Heat Number(s): 20965370

Nut Mfg. Lot Number(s): BWCV

Washer Mfg. Lot Number(s): N/A

Bolt Specification: N/A

Bolt Length(s): N/A

Nut Specification: A563

Washer Specification: N/A

Finish: Plain

Diameter/Size: 2-1/2"

Bolt Mfg. Lot Number: N/A

Rocap Test Requirement(s): No

Lubricant Requirements(s): No

Washer Inner Diameter(s): 0