Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993812 DEA: 11431274 EFIS: 1121000129
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5-R0.3/R36.0
Work Description: CMGC Project- Restore the pavement to a state of good repair through roadway rehabilitation, pavement preservation, drainage restoration, transportation management system upgrades, and American with Disabilities Act (ADA) infrastructure improvements.
Location Description: SD County
Contractor Name: Kiewit Infrastrucure
Contractor Address: West 2200 Columbia House Boulevard, Vancouver, WA 98661
Resident Engineer: Timothy Poppe Structure Rep.: Unknown
DIME Sample ID: 2026-06-25-20
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: 07/07/2026
The quantity of what the sample constitutes: 130
A brief description of the sample: A325
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): E438S1
Nut Mfg. Lot Number(s): na
Washer Mfg. Lot Number(s): na
Bolt Specification: A325
Bolt Length(s): 4-1/2"
Nut Specification: na
Washer Specification: na
Finish: MG
Diameter/Size: 1-1/4"
Bolt Mfg. Lot Number: M6227
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
