Sample Record for 2026-04-22-4

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

Project Information

Project ID: 1001404 DEA: 120S3804 EFIS: 1220000058 QA Service Level: 1

DIST-CO-RTE-PM: 12-ORA-5-10.0/21.3

Work Description: SLAB REPLACEMENT (RSC), RHMA-PAVING, SIGNAL AND LIGHTING MODIFICATION.

Location Description: ORANGE COUNTY FROM EL HORNO STREET UNDERCROSSING IN SAN JUAN CAPISTRANO TO ROUTE 405/5 SEPARATION IN IRVINE

Contractor Name: Beador Construction

Contractor Address: 2900 Bristol Street, Suite D 204, Costa Mesa, CA 92626

Resident Engineer: Artin Merati Structure Rep.: Michael Yee

DIME Sample ID: 2026-04-22-4

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: 04/22/2026

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

The quantity of what the sample constitutes: 300 pcs

A brief description of the sample: 3" Heavy Hex Nut

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Blue Circle Corporation

Rocap Number(s): N/A

Heat Number(s): A244893

Nut Mfg. Lot Number(s): BZHN

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

Bolt Specification: N/A

Bolt Length(s): N/A

Nut Specification: ASTM A194

Washer Specification: N/A

Finish: ASTM A153

Diameter/Size: 3"

Bolt Mfg. Lot Number: M/A

Rocap Test Requirement(s): None

Lubricant Requirements(s): None

Washer Inner Diameter(s): None