Sample Record for 2026-10-07-5
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001197 DEA: 07319604 EFIS: 0716000025
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-1,101-21.3/21.9,R34.9/R36.1
Work Description: REMOVE AND CONSTRUCT BRIDGE.
Location Description: VENTURA COUNTY ON ROUTE 1 FROM 1.8 MILES NORTH OF ROUTE 1/33 SEPARATION TO 2.0 MILES SOUTH OF A LEASE CANYON ROAD AND ON ROUTE 101 FROM 0.4 MILE NORTH OF DULAH ROAD UNDERCROSSING TO SAN MIGUELITO ROAD UNDERCROSSING
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 BRISTOL STREET, SUITE D204, COSTA MESA, CA 92626
Resident Engineer: Ranjit Singh Structure Rep.: Aziz Maghsoudloo
Sample Information
DIME Sample ID: 2026-10-07-5
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: 10/07/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/07/2026
The quantity of what the sample constitutes: 1 Sample from 26 ea.
A brief description of the sample: 1"x20" ASTM F1554 grade 55 Anchor Bolts
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo Structural Products
Material Information
Rocap Number(s): Na
Bolt Heat Number: 20948400
Nut Heat Number: 8000027695
Washer Heat Number: 240419
Nut Mfg. Lot Number(s): W000222141
Washer Mfg. Lot Number(s): E7373
Bolt Specification: 1554 grade 55
Bolt Length(s): 20"
Nut Specification: ASTM 563
Washer Specification: F436
Bolt Galvanization: Hot Dip Galvanized
Nut Galvanization: Hot Dip Galvanized
Washer Galvanization: Hot Dip Galvanized
Bolt Diameter: 1.25"
Nut Diameter: 1.25
Washer Diameter: 1.25
Bolt Mfg. Lot Number: Lot 1
Rocap Test Requirement(s): na
Lubricant Requirements(s):
Washer Inner Diameter(s):
Bolt Mill Supplier: Charter Steel
Nut Mill Supplier: Nucor Fastener
Washer Mill Supplier: Prestige Stamping
Test Results
