Sample Record for 2026-07-08-9

Project ID: 214469 DEA: 030H08U4 EFIS: 0319000029 QA Service Level: 1

DIST-CO-RTE-PM: 03-SAC-50-L0.2/R6.1

Work Description: Sac 50 Design Build PLEASE NOTE THAT DESIGN BUILDER MUST PERFORM QUALITY VALIDATION TESTING IN ACCORDANCE WITH THE MATERIAL CONTROL SCHEDULE (MCS) FOR ITEMS SUCH AS STRANDS, HS BOLTS, ELASTOMERIC BEARING PADS, JOINT SEALANTS, COUPLERS & WELDED HOOPS, ETC

Location Description: FROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE

Contractor Name: FLATIRON WEST INC

Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510

Resident Engineer: John Ruzic Structure Rep.: Conor Hennessy

DIME Sample ID: 2026-07-08-9

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: 2 of 26

A brief description of the sample: F1554 Gr.36 All Thread

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): 8000038347

Nut Mfg. Lot Number(s): none

Washer Mfg. Lot Number(s): none

Bolt Specification: F1554 Gr.36

Bolt Length(s): 9"

Nut Specification: none

Washer Specification: none

Finish: Galvanized

Diameter/Size: 7/8

Bolt Mfg. Lot Number: 8000038347

Rocap Test Requirement(s): none

Lubricant Requirements(s): none

Washer Inner Diameter(s): none