Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001612 DEA: 051P2104 EFIS: 0521000188
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON, -1-44.3
Work Description: CONSTRUCT SOLDIER PILE WALL AND STRUCTURAL CONCRETE BARRIER SLAB.
Location Description: MONTEREY COUNTY NEAR BIG SUR ABOUT 1.1 MILES SOUTH OF PFEIFFER CANYON BRIDGE
Contractor Name: Graniterock Company
Contractor Address: 350 Technology Drive, Watsonville, CA 95076
Resident Engineer: Tommy Munro Structure Rep.: Carson Sperber
DIME Sample ID: 2026-06-04-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 06/04/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/19/2026
The quantity of what the sample constitutes: 114
A brief description of the sample: Hex Bolt 1-1/4" x 24 w/6" of thread
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales Inc.
Rocap Number(s): na
Heat Number(s): 1000231022
Nut Mfg. Lot Number(s): na
Washer Mfg. Lot Number(s): na
Bolt Specification: F1554 GR 105
Bolt Length(s): 24"
Nut Specification: na
Washer Specification: na
Finish: HDG
Diameter/Size: 1-1/4"
Bolt Mfg. Lot Number: 4514
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
