Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213741 DEA: 07325704 EFIS: 0716000089
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-1.7
Work Description: BUILDING CONSTRUCTION IN LOS ANGELES COUNTY IN SANTA FE SPRINGS AT 14044 FREEWAY DRIVE.
Location Description: Santa Fe Springs, At 14044 Freeway Drive.
Contractor Name: AWI Builders Inc
Contractor Address: 7831 Paramount Bl, Pico Rivera Ca 90660
Resident Engineer: Mashhur Ali Structure Rep.: Nelson Parada
DIME Sample ID: 2020-09-14-3
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: Retest
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/14/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/18/2020
The quantity of what the sample constitutes: 30
A brief description of the sample: 5/8" washers
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bristol Machine
Rocap Number(s):
Heat Number(s): 4158468
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): D6245
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: N/A
Washer Specification: ASTM F436
Finish: Black
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s):
Lubricant Requirements(s):
