Sample Record for 2026-06-25-18
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1002102 DEA: 081P9904 EFIS: 0824000205
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-138-15.264
Work Description: SIGNAL AND LIGHTING SYSTEM. CONSTRUCTION ON STATE HIGHWAY IN SAN BERNARDINO COUNTY NEAR HESPERIA AT ROUTE 15 SOUTHBOUND RAMPS AND AT ROUTE 15 NORTHBOUND RAMPS
Location Description:
Contractor Name: KANAAN CONSTRUCTION
Contractor Address: 230 S IRWINDALE AVE, Azusa, CA 91702
Resident Engineer: Roberto Flores Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-06-25-18
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: 06/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/25/2026
The quantity of what the sample constitutes: 400
A brief description of the sample: 2.25" x 42" Double End Studs
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo
Material Information
Rocap Number(s): No
Heat Number(s): 79018794, 401220795, 21005610, 22520370
Nut Mfg. Lot Number(s): BZKS
Washer Mfg. Lot Number(s): 419358
Bolt Specification: F1554
Bolt Length(s): 42"
Nut Specification: A563
Washer Specification: F436
Finish: Galvanized
Diameter/Size: 1"
Bolt Mfg. Lot Number: 79018794
Rocap Test Requirement(s): No
Lubricant Requirements(s): No
Washer Inner Diameter(s): TWO ONE QUARTER
Test Results
