Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001075 DEA: 040W0304 EFIS: 0420000164
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-0.02/6.3
Work Description: Replace existing tolling structure with open road tolling (ORT) system at the Richmond-San Rafael.
Location Description:
Contractor Name: FLATIRON WEST INC.
Contractor Address: 1200 Concord Ave Suite 465, Concord, CA 94520
Resident Engineer: William Sommer Structure Rep.: Eric Racadag
DIME Sample ID: 2026-09-09-44
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
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: 09/30/2026
The quantity of what the sample constitutes: 880
A brief description of the sample: 1 1/4-7 X 3 1/2 F3125
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Acrow
Rocap Number(s): NA
Heat Number(s): NA
Nut Mfg. Lot Number(s): W000329813
Washer Mfg. Lot Number(s): E9450
Bolt Specification: F3125
Bolt Length(s): 3 1/2
Nut Specification: A563
Washer Specification: ASTM F844
Finish: HDG
Diameter/Size: 1 1/4-7 X 3 1/2
Bolt Mfg. Lot Number: E399X1
Rocap Test Requirement(s): NA
Lubricant Requirements(s): NA
Washer Inner Diameter(s): NA
Bolt Mill Supplier:
Nut Mill Supplier:
Washer Mill Supplier:
DIME Test ID: 2026-09-09-44-1
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
DIME Test ID: 2026-09-09-44-2
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
