Sample Record for 2026-07-16-5
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001280 DEA: 033J9004 EFIS: 0323000033
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-160-R44.9
Work Description: MODIFY SIGNAL AND LIGHTING SYSTEMS.
Location Description: SACRAMENTO COUNTY IN SACRAMENTO AT 0.1 MILE SOUTH OF NORTH SACRAMENTO UNDERCROSSING
Contractor Name: PACIFIC INFRASTRUCTURE CONSTRUCTION, LLC
Contractor Address: 871 ,cotting court, Suite A, Vacaville CA, 95688
Resident Engineer: Jony Tji Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-07-16-5
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: 07/16/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2
A brief description of the sample: 1-1/2" x 3-1/2" ASTM A325 Bolt Assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ameron Pole Products
Material Information
Rocap Number(s): NA
Heat Number(s): Bolt 58063674
Nut 1000115365
Washer 241930
Nut Mfg. Lot Number(s): W000302823
Washer Mfg. Lot Number(s): 0125-526
Bolt Specification: ASTM A325
Bolt Length(s): 3-1/2"
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 1-1/2"
Bolt Mfg. Lot Number: 112625-1CE
Rocap Test Requirement(s): NA
Lubricant Requirements(s): NA
Washer Inner Diameter(s): NA
Test Results
