Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001125 DEA: 07348504 EFIS: 0718000143
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-2-15.0/26.5
Work Description: CONSTRUCT ADA CURB RAMPS AND MODIFY SIGNAL AND LIGHTING SYSTEM.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS FROM RIVERSIDE DRIVE TO GOULD MESA
Contractor Name: YAKAR
Contractor Address: Unknown
Resident Engineer: Bill Tran Structure Rep.: Unknown
DIME Sample ID: 2026-09-09-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/09/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 3000
A brief description of the sample: 5/8" x 1-3/4" Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ameron Pole Products
Rocap Number(s): N/A
Heat Number(s): 1000122173
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: HDG
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: W000115238
Rocap Test Requirement(s): 0
Lubricant Requirements(s): 0
Washer Inner Diameter(s): 0
Bolt Mill Supplier:
Nut Mill Supplier:
Washer Mill Supplier:
