Sample Record for 2026-04-01-70
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995488 DEA: 051C9504 EFIS: 0513000018
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-R36.0/R37.0
Work Description: COLD PLANE AC PVMT, RHMA, LIGHTING SYSTEMS, AND REPLACE BRIDGES.
Location Description: SANTA BARBARA COUNTY ABOUT 8.0 MILES WEST OF GOLETA FROM 0.6 MILE EAST OF REFUGIO ROAD UNDERCROSSING TO 0.4 MILE WEST OF REFUGIO ROAD UNDERCROSSING.
Contractor Name: M.C.M. CONSTRUCTION, INC.
Contractor Address: 6413 32nd Street, North Highlands, CA 95660
Resident Engineer: Jacob Cooper Structure Rep.: Clifford Replogle
Sample Information
DIME Sample ID: 2026-04-01-70
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: 04/21/2026
The quantity of what the sample constitutes: 1170
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
Material Information
Rocap Number(s): N/A
Heat Number(s): 21007710
Nut Mfg. Lot Number(s): BZRA
Washer Mfg. Lot Number(s): N/A
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: A563
Washer Specification: N/A
Finish: Galv
Diameter/Size: 2"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): No
Lubricant Requirements(s): yes
Washer Inner Diameter(s): 0
Test Results
