Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995026 DEA: 040Q1004 EFIS: 0418000044
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-20.7/30.8
Work Description: REHAB ALA 580
Location Description: ALAMEDA COUNTY IN PLEASANTON AND CASTRO VALLEY FROM ROUTE 680/580 SEPARATION TO ROUTE 580/238 SEPARATION
Contractor Name: FBD VANGUARD CONSTRUCTION, INC.
Contractor Address: 550 Greenville Road, Livermore, CA 94550
Resident Engineer: Paramjit Pandher Structure Rep.: John Parecadan
DIME Sample ID: 2026-06-25-6
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: 06/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/25/2026
The quantity of what the sample constitutes: 17920
A brief description of the sample: A563 Hex Nut
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): 10987450
Nut Mfg. Lot Number(s): 25-56-010
Washer Mfg. Lot Number(s): na
Bolt Specification: na
Bolt Length(s): na
Nut Specification: A563 Gr A
Washer Specification: na
Finish: HDG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: na
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
