Sample Record for 2026-07-14-22

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

Project Information

Project ID: 1000028 DEA: 081J8404 EFIS: 0818000121 QA Service Level: 1

DIST-CO-RTE-PM: 08-SBD-40,58,62,95-Var

Work Description: INSTALL CMS SYSTEM, FURNISH SIGN STRUCTURE, AND SIGN FOUNDATION.

Location Description: SAN BERNARDINO COUNTY AT VARIOUS LOCATIONS

Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.

Contractor Address: 16351 CONSTRUCTION CIRCLE WEST, IRVINE, CA 92606

Resident Engineer: Khoa Nguyen Structure Rep.: Alex Naime

DIME Sample ID: 2026-07-14-22

TL Number from the TL Form:

Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office

Sample Organization Contact: (916) 2058871

Type of Sample: Stock

Type of Material: SMTL TM3 - Fastener Assembly

Sample Taken Date: 07/14/2026

Date that the sample was received by the laboratory/organization performing the testing: 07/14/2026

The quantity of what the sample constitutes: 600

A brief description of the sample: 1/2"x2-1/2" A325 Hex Bolt

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Universal Industrial Sales

Rocap Number(s): N/A

Heat Number(s): 10809230

Nut Mfg. Lot Number(s): N/A

Washer Mfg. Lot Number(s): N/A

Bolt Specification: A325

Bolt Length(s): 2-1/2"

Nut Specification: N/A

Washer Specification: N/A

Finish: Mech. Galv.

Diameter/Size: 1/2"

Bolt Mfg. Lot Number: M6357

Rocap Test Requirement(s): 0

Lubricant Requirements(s): 0

Washer Inner Diameter(s): 0