Sample Record for 2022-11-10-17
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994220 DEA: 024J3204 EFIS: 0223000012
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS/SIS-96-0/105.82
Work Description: Remove and dispose of hazard trees, replace burnt wood posts, replace damaged culverts, install system hardening components (drainage, slopes, etc.) repair/replace damaged pavement, repair bridge damage and other miscellaneous associated items of work.
Location Description:
Contractor Name: HAYES & SONS, INC.
Contractor Address: PO BOX 258, HAPPY CAMP, CA 96039
Resident Engineer: Nicole Mallory Structure Rep.: Jacob Back
Sample Information
DIME Sample ID: 2022-11-10-17
TL Number from the TL Form: C926092
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: 11/10/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 314 ea
A brief description of the sample: 7/8 x2 A325 HDG fastener assemblies
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bay Bolt
Material Information
Rocap Number(s): 1706-01
Heat Number(s): Bolt 10695940
Nut 8000014475
washer 32028550
Nut Mfg. Lot Number(s): 472199B
Washer Mfg. Lot Number(s): 167117
Bolt Specification: A325
Bolt Length(s): 2"
Nut Specification: A563
Washer Specification: F436
Finish: HDG
Diameter/Size: 7/8
Bolt Mfg. Lot Number: L737V1
Rocap Test Requirement(s): yes
Lubricant Requirements(s): yes
Test Results
