Sample Record for 2026-06-25-23
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994415 DEA: 120R3114 EFIS: 1220000021
QA Service Level: 1
DIST-CO-RTE-PM: 12-LA,ORA-91-R20.6/R20.7,R0.0/4.8
Work Description: PLACE JPCP (RSC) AND RHMA, AND MODIFY ELECTRICAL SYSTEMS.
Location Description: LOS ANGELES AND ORANGE COUNTIES FROM 0.1 MILE WEST OF THE LOS ANGLES COUNTY LINE IN CERRITOS TO 0.1 MILE EAST OF ACACIA STREET UNDERCROSSING IN ANAHEIM
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Bill Gilchrist Structure Rep.: Mahesh Kapoor
Sample Information
DIME Sample ID: 2026-06-25-23
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: 12
A brief description of the sample: 1.25" Washers (Replacement)
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): 148668
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): 148668
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: N/A
Washer Specification: N/A
Finish: Galvanized
Diameter/Size: 1.25" Washers
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): No
Lubricant Requirements(s): No
Washer Inner Diameter(s): one and seven sixteenths
Test Results
