Sample Record for 2019-08-26-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213570 DEA: 033F5504 EFIS: 0313000137
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL,SAC-275-13.0,0.0
Work Description: REPLACE TIMBER FENDER SYSTEM SURROUNDING PIERS 6 AND 7
Location Description: YOLO AND SACRAMENTO COUNTIES IN WEST SACRAMENTO AND SACRAMENTO AT SACRAMENTO RIVER BRIDGE.
Contractor Name: Golden State Bridge
Contractor Address: 2990 Bay Vista Court, Benicia, CA 94510
Resident Engineer: Anthony Thurman Structure Rep.: Brent Bullard
Sample Information
DIME Sample ID: 2019-08-26-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Department Acceptance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 08/26/2019
Date that the sample was received by the laboratory/organization performing the testing: 08/26/2019
The quantity of what the sample constitutes: 4,000
A brief description of the sample: A325 HDG BOLT ASSEMBLY
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Tower Bridge
The fabricator/manufacturer/facility name: Golden State Bridge
Material Information
Rocap Number(s): Not Required
Heat Number(s): 100889992, 100892134, 752109
Nut Mfg. Lot Number(s): 2734775068952
Washer Mfg. Lot Number(s): 303371
Bolt Specification: A325
Bolt Length(s): 3.75"
Nut Specification: ASTM A563
Washer Specification: ASME B18.21.1
Finish: HDG
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: 404635A, 414509A, 752109
Rocap Test Requirement(s): Not Required
Lubricant Requirements(s): Lubricated Blue Dye
Test Results
