Sample Record for 2026-07-08-6

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

Project Information

Project ID: 1001640 DEA: 010N2904 EFIS: 0123000202 QA Service Level: 1

DIST-CO-RTE-PM: 01-DN-197,199-Var

Work Description: REPLACE BRIDGE, EXCAVATION, AND RETAINING WALLS.

Location Description: DEL NORTE COUNTY AT VARIOUS LOCATIONS

Contractor Name: McCullough Construction, Inc.

Contractor Address: 57 Aldergrove Rd, Arcata, CA 95521

Resident Engineer: Aaron Valley Structure Rep.: Joshua Erler

DIME Sample ID: 2026-07-08-6

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: 07/08/2026

Date that the sample was received by the laboratory/organization performing the testing: 07/20/2026

The quantity of what the sample constitutes: 4 OF 73,516

A brief description of the sample: 3/4" A563 Hex Nut HDG (Wax and Dye)

From where was the sample collected: Source

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: UIS Lindon UT

Rocap Number(s): NONE

Heat Number(s): 5806869906

Nut Mfg. Lot Number(s): N0164-S-5806869906

Washer Mfg. Lot Number(s): none

Bolt Specification: none

Bolt Length(s): none

Nut Specification: A563 Gr. HD Hvy Hex Nut

Washer Specification: none

Finish: Galvanize

Diameter/Size: 3/4

Bolt Mfg. Lot Number: none

Rocap Test Requirement(s): none

Lubricant Requirements(s): Wax

Washer Inner Diameter(s): none