Sample Record for 2026-06-23-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001538 DEA: 07350704 EFIS: 0719000039
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405,5,101,105,405-19.2/25.95
Work Description: LA-405 TMS Upgrades near LAX (Active Traffic Management and Integrated Corridor Management) Installing new sign structures with CMS
Location Description: Interstate 405 near LAX Airport
Contractor Name: Parsons
Contractor Address: 19900 MacArthur Blvd. Suite 850, Irvine, CA 92612
Resident Engineer: Ali Karout Structure Rep.: Mark Amorsolo
Sample Information
DIME Sample ID: 2026-06-23-3
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: 06/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/03/2026
The quantity of what the sample constitutes: 266
A brief description of the sample: 2.5" X 60" ROD F1554 Gr. 55 (18" GALV) 12" Top 6" Bottom
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Madden Bolt
Material Information
Rocap Number(s): N/A
Heat Number(s): 20810200, 32507650, 21009800, W6C834, 591291186
Nut Mfg. Lot Number(s): DEHC, BZMZ
Washer Mfg. Lot Number(s): 0425-637
Bolt Specification: F1554
Bolt Length(s): 60"
Nut Specification: A563
Washer Specification: F436
Finish: Galvanized and bare
Diameter/Size: 2.5"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): NO
Lubricant Requirements(s): NO
Washer Inner Diameter(s): Four point Six two five inches
Test Results
