Sample Record for 2026-10-14-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 210094 DEA: 040G3604 EFIS: 0400000326 COOP: 042553A1,042981
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-880,880-31.0/32.4
Work Description: I-880 BROADWAY/ JACKSON INTERCHANGE: Modify Ramps, Hma Pvmt, Bridges, Drainage, Signals, Sw And Bikeway
Location Description: IN ALA COUNTY
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: 1450 Civic Ct. Bbld. B, Suit 400, Concord CA, 94520
Resident Engineer: Cecilia Zamora Structure Rep.: Kristen Wu
Sample Information
DIME Sample ID: 2026-10-14-1
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: 10/14/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/20/2026
The quantity of what the sample constitutes: 1000
A brief description of the sample: 1 1/2" x 4 1/2" Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ameron Poles Oklahoma
Material Information
Rocap Number(s): no
Bolt Heat Number: 58067396
Nut Heat Number: no
Washer Heat Number: no
Nut Mfg. Lot Number(s): no
Washer Mfg. Lot Number(s): no
Bolt Specification: ASTM A325
Bolt Length(s): 4 1/2"
Nut Specification: no
Washer Specification: no
Bolt Galvanization: ASTM F2329
Nut Galvanization: no
Washer Galvanization: no
Bolt Diameter: 1 1/2"
Nut Diameter: no
Washer Diameter: no
Bolt Mfg. Lot Number: 121625-1CE
Rocap Test Requirement(s): no
Lubricant Requirements(s):
Washer Inner Diameter(s):
Bolt Mill Supplier: Gerdau
Nut Mill Supplier: no
Washer Mill Supplier: no
Test Results
