Sample Record for 2021-02-10-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213406 DEA: 030F2504 EFIS: 0300000075
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL,SAC-80-R11.1/R11.7,M0.0/M0.5
Work Description: SAC RIVER BOH (BRYTE BEND)
Location Description: SACRAMENTO AND YOLO COUNTIES IN WEST SACRAMENTO AND SACRAMENTO FROM 0.1 MILE WEST OF REED AVENUE UNDERCROSSING TO 0.1 MILE EAST OF SACRAMENTO RIVER BRIDGE AND OVERHEAD
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST LLC
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Ephrem Teweldeberhan Structure Rep.: Brent Bullard
Sample Information
DIME Sample ID: 2021-02-10-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 02/10/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 16,689 washers
A brief description of the sample: 5/8" F436 Washers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CK Johnson
Material Information
Rocap Number(s): 443696A and 448446A
Heat Number(s): B57380
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): E0076
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: N/A
Washer Specification: ASTM F436
Finish: ASTM F2329 AND A153 HDG
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): YES
Lubricant Requirements(s):
Test Results
