Sample Record for 2026-08-25-5

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

Project Information

Project ID: 1000403 DEA: 120K91U4 EFIS: 1222000031 QA Service Level: 1

DIST-CO-RTE-PM: 12-ORA-91-R9.2/R11.4

Work Description: CONST BRIDGES, RW, SW, PAVEMENT, DRAINAGE AND ELECTRICAL SYSTEMS.

Location Description: ORANGE COUNTY IN ANAHEIM FROM 0.9 MILE WEST TO 1.3 MILES EAST OF LAKEVIEW AVENUE OVERCROSSING

Contractor Name: GRANITE CONSTRUCTION COMPANY

Contractor Address: 16700 Valley View Avenue Suite 300

Resident Engineer: Steve Kinaly Structure Rep.: Wei-Jen Lee

DIME Sample ID: 2026-08-25-5

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: 08/25/2026

Date that the sample was received by the laboratory/organization performing the testing: 08/25/2026

The quantity of what the sample constitutes: 4000

A brief description of the sample: 1" DTI 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): 242500

Nut Mfg. Lot Number(s): n/a

Washer Mfg. Lot Number(s): ABTKX2

Bolt Specification: n/a

Bolt Length(s): n/a

Nut Specification: n/a

Washer Specification: F959-DTI

Finish: Mech. Galvanization

Diameter/Size: 1"

Bolt Mfg. Lot Number: n/a

Rocap Test Requirement(s): 0

Lubricant Requirements(s): 0

Washer Inner Diameter(s): 0