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Sample Record for 2023-08-04-16

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 215421 DEA: 042K9504 EFIS: 0417000057 QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-14.4/14.4
Work Description: CONSTRUCT MATERIAL TESTING LABORATORY BUILDING.
Location Description: ALAMEDA COUNTY IN LIVERMORE AT 2201 KITTY HAWK ROAD
Contractor Name: Walsh Construction Company II, LLC (Walsh) - Dominic Fung
Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520
Resident Engineer: Amir-Fardin Sadeghi-Nedjad Structure Rep.: John Parecadan

Sample Information

DIME Sample ID: 2023-08-04-16
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: 08/04/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 280
A brief description of the sample: 3/4" x 2.25" TC Bolt
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LB Construction

Material Information

Rocap Number(s):
Heat Number(s): 1000219817
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: F3125 GR F1852
Bolt Length(s): 2.25"
Nut Specification: NA
Washer Specification: NA
Finish: Black
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: w000073239
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Results