Sample Record for 2026-06-16-34

Project ID: 1001248 DEA: 120K93U4 EFIS: 1224000084 QA Service Level: 1

DIST-CO-RTE-PM: 12-ORA-57,91-13.9/16.1,4.8/6.6

Work Description: CONST BRIDGES, RW, SW, PAVEMENT, DRAINAGE AND ELECTRICAL SYSTEMS.

Location Description: ANAHEIM AND PLACENTIA ON ROUTE 57 FROM WAGNER AVENUE OVERCROSSING TO 0.2 MILE NORTH OF MIRALOMA AVENUE OVERCROSSING AND ON ROUTE 91 FROM 0.1 MILE EAST OF ACACIA STREET UNDERCROSSING TO 0.2 MILE EAST OF LA PALMA AVENUE OVERCROSSING

Contractor Name: OHLA USA, INC

Contractor Address: 2550 East Miraloma Way, Suite 200, Anaheim, CA 92806

Resident Engineer: Charlie Nakamoto Structure Rep.: Lance Yamashiro

DIME Sample ID: 2026-06-16-34

TL Number from the TL Form:

Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory

Sample Organization Contact: 9166394315

Type of Sample: Stock

Type of Material: SMTL TM3 - Fastener Assembly

Sample Taken Date: 06/16/2026

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

The quantity of what the sample constitutes: 1300

A brief description of the sample: 2-1/2" F436 Flat Washers

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: UIS

Rocap Number(s): N/A

Heat Number(s): 241915

Nut Mfg. Lot Number(s): xxx

Washer Mfg. Lot Number(s): 55420

Bolt Specification: xxx

Bolt Length(s): xxx

Nut Specification: xxx

Washer Specification: F436

Finish: HDG

Diameter/Size: 2-1/2"

Bolt Mfg. Lot Number: xxx

Rocap Test Requirement(s): xxx

Lubricant Requirements(s): xxx

Washer Inner Diameter(s): xxx