Sample Record for 2026-10-06-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Vicente Bunyi Structure Rep.: Luis Negrete
Sample Information
DIME Sample ID: 2026-10-06-6
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: 10/06/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/21/2026
The quantity of what the sample constitutes: 500 pcs
A brief description of the sample: ASTM A325 3/4"x 2-1/2" Bolt
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ameron Pole Products
Material Information
Rocap Number(s): NA
Heat Number(s): 1000131933
Nut Mfg. Lot Number(s): NA
Washer Mfg. Lot Number(s): NA
Bolt Specification: ASTM A325/F3125
Bolt Length(s): 2-1/2"
Nut Specification: N/A
Washer Specification: NA
Finish: Hot Dip Galvanized
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: 022426-1BE
Rocap Test Requirement(s): NA
Lubricant Requirements(s): Blue Wax
Washer Inner Diameter(s): NA
Bolt Mill Supplier: NA
Nut Mill Supplier: NA
Washer Mill Supplier: NA
Test Results
