Sample Record for 2026-08-25-13

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

Project Information

Project ID: 1000611 DEA: 120R32U4 EFIS: 1222000054 QA Service Level: 1

DIST-CO-RTE-PM: 12-ORA-55-0.2/R17.8

Work Description: COLD PLANE, PLACE RHMA, REPLACE CB, SIGNS AND MODIFY LIGHTING SYSTEM.

Location Description: ORANGE COUNTY FROM 0.1 MILE SOUTH OF ROUTE 55/1 SEPARATION IN NEWPORT BEACH TO ROUTE 55/91 SEPARATION IN ANAHEIM

Contractor Name: R.J. NOBLE COMPANY

Contractor Address: 15505 East Lincoln Avenue, Orange, CA 92865

Resident Engineer: Tyrone Taylor Structure Rep.: Matthew Chang

DIME Sample ID: 2026-08-25-13

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: 419

A brief description of the sample: 5/8" x 1-3/4" 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): 10958180

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

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

Bolt Specification: A325

Bolt Length(s): 1-3/4"

Nut Specification: n/a

Washer Specification: n/a

Finish: Mech. Galvanization

Diameter/Size: 5/8"

Bolt Mfg. Lot Number: M6256

Rocap Test Requirement(s): 0

Lubricant Requirements(s): 0

Washer Inner Diameter(s): 0