Sample Record for 2026-08-27-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000004 DEA: 033H5604 EFIS: 0318000014
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA,NEV-20,80-VAR
Work Description: STRUCTURAL CONC, BAR REINFORCING STEEL, BRIDGE REMOVAL, HMA, AND JPCP.
Location Description: PLACER AND NEVADA COUNTIES NEAR CISCO GROVE ON ROUTE 80 FROM 0.4 MILE WEST OF LAKE VALLEY OVERCROSSING TO 0.9 MILE EAST OF YUBA PASS SEPARATION AND OVERHEAD AND ON ROUTE 20 AT YUBA PASS SEPARATION AND OVERHEAD
Contractor Name: FLATIRON WEST INC.
Contractor Address: 1200 Concord Ave Suite 465, Concord, CA 94520
Resident Engineer: Tad Sampson Structure Rep.: James 'Jimmer' Ross
Sample Information
DIME Sample ID: 2026-08-27-1
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: 08/27/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/27/2026
The quantity of what the sample constitutes: 1 of 13pcs
A brief description of the sample: F1554 anchor rods
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corp
Material Information
Rocap Number(s): n/a
Heat Number(s): 3147142
Nut Mfg. Lot Number(s): n/a
Washer Mfg. Lot Number(s): n/a
Bolt Specification: F1554
Bolt Length(s): 72"
Nut Specification: n/a
Washer Specification: n/a
Finish: Galvanize
Diameter/Size: 3"
Bolt Mfg. Lot Number: 86871147/147142A106
Rocap Test Requirement(s): none
Lubricant Requirements(s): none
Washer Inner Diameter(s): none
Test Results
