Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210037 DEA: 043G4424 EFIS: 0412000042
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-80-R5.6/7.6
Work Description: WEST SPAN DAMPER BRACKET A325 BOLT TESTING
Location Description: SFOBB WEST SPAN
Contractor Name: CALIFORNIA ENGINEERING CONTRACTORS, INC.
Contractor Address: 20 Happy Valley Road, Pleasanton, CA 94566
Resident Engineer: Tom Larwin Structure Rep.: Sergio Gomez
DIME Sample ID: 2019-05-10-8
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: 05/10/2019
Date that the sample was received by the laboratory/organization performing the testing: 05/14/2019
The quantity of what the sample constitutes: 354
A brief description of the sample: 1" dia A490 bolt assemblies
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: California Engineering Contractor
Rocap Number(s): TT0113074
Heat Number(s): 10426680
Nut Mfg. Lot Number(s): 29402-6214745403
Washer Mfg. Lot Number(s): D6838
Bolt Specification: A490
Bolt Length(s): 9"
Nut Specification: A563-DH
Washer Specification: F436
Finish: plain
Diameter/Size: 1"
Bolt Mfg. Lot Number: 040810
Rocap Test Requirement(s):
Lubricant Requirements(s):
