Sample Record for 2026-06-10-18
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001360 DEA: 09374804 EFIS: 0918000020
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-395-115.0
Work Description: BUILDING WORK AND PLACE HMA (TYPE A).
Location Description: INYO COUNTY IN BISHOP AT THE DISTRICT OFFICE AT 500 SOUTH MAIN STREET
Contractor Name: BOWE CONTRACTORS INC.
Contractor Address: 609 Bailey Ct, Tehachapi, CA 93561
Resident Engineer: David Carruba Structure Rep.: Mulugheta Belay
Sample Information
DIME Sample ID: 2026-06-10-18
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 06/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/22/2026
The quantity of what the sample constitutes: 7
A brief description of the sample: 3/8" X 120" Galv Anchor Bolts
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cordova Bolt Inc. Buena Park, CA.
Material Information
Rocap Number(s): N/A
Heat Number(s): 1000230099, 10855090, 22516570
Nut Mfg. Lot Number(s): 24-49-019
Washer Mfg. Lot Number(s): 417692
Bolt Specification: F1554
Bolt Length(s): 120"
Nut Specification: A563
Washer Specification: F436
Finish: Galvanized
Diameter/Size: 3/8"
Bolt Mfg. Lot Number: 2508152-20A
Rocap Test Requirement(s): No
Lubricant Requirements(s): Yes
Washer Inner Diameter(s): seven sixteen
Test Results
Test
DIME Test ID: 2026-06-10-18-1
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
