Sample Record for 2026-07-14-37

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

Project Information

Project ID: 1000320 DEA: 11430324 EFIS: 1118000102 QA Service Level: 1

DIST-CO-RTE-PM: 11-SD-805-14.6/23.7

Work Description: MODIFY ELECTRICAL, CONCRETE PAVEMENT, DRAINAGE AND SIGNS.

Location Description: SAN DIEGO COUNTY IN SAN DIEGO FROM ROUTE 805/15 SEPARATION TO 0.1 MILE NORTH OF ROUTE 805/52 SEPARATION

Contractor Name: COFFMAN SPECIALTIES, INC.

Contractor Address: 9685 VIA EXCELENCIA STE 200, SAN DIEGO, CA 92126

Resident Engineer: Art Pannu Structure Rep.: Jose Delgado

DIME Sample ID: 2026-07-14-37

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: 2000

A brief description of the sample: 1-1/8" F436 Flat Washer

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): 226005

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

Washer Mfg. Lot Number(s): 46556-226005

Bolt Specification: N/A

Bolt Length(s): N/A

Nut Specification: N/A

Washer Specification: F436

Finish: Mech. Galv.

Diameter/Size: 1-1/8"

Bolt Mfg. Lot Number: N/A

Rocap Test Requirement(s): 0

Lubricant Requirements(s): 0

Washer Inner Diameter(s): 0