Sample Record for 2026-06-25-28

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 995204 DEA: 07325804 EFIS: 0716000090 QA Service Level: 1

DIST-CO-RTE-PM: 07-LA-1-18.0/33.3

Work Description: COLD PLANE AND OVERLAY ASPHALT CONCRETE PAVEMENT, INSTALL CURB RAMPS.

Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS ON ROUTE 1 FROM PASEO DE LAS DELICIAS TO DEWEY STREET

Contractor Name: RJ Noble Company

Contractor Address: 15505 E. Lincoln Ave, Orange, CA 92865

Resident Engineer: Huy Ngo Structure Rep.: Unknown

DIME Sample ID: 2026-06-25-28

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: 49

A brief description of the sample: 3" x 60" Double End Studs

From where was the sample collected: Source

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Halo

Rocap Number(s): No

Heat Number(s): 256622, A244893, 140694, 190155263

Nut Mfg. Lot Number(s): BZHN

Washer Mfg. Lot Number(s): 52257190155263, S3323675

Bolt Specification: F1554

Bolt Length(s): 60"

Nut Specification: A563

Washer Specification: F436

Finish: Galvanized

Diameter/Size: 3

Bolt Mfg. Lot Number: 256622

Rocap Test Requirement(s): No

Lubricant Requirements(s): No

Washer Inner Diameter(s): three inches and one eighth