Sample Record for 2023-09-25-77
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215620 DEA: 01436404 EFIS: 0100000193
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-35.8/36.5
Work Description: Dr. Fine Bridge Replacement
Location Description: DR. FINE BRIDGE REPLACEMENT FROM LAKE EARL DR TO S FRED D. HAIGHT DR ON HWY 101 ACROSS SMITH RIVER.
Contractor Name: MCM Construction
Contractor Address: PO Box 620, North Highlands, Ca 95660
Resident Engineer: Clayton Malmberg Structure Rep.: Brian Cinkutis
Sample Information
DIME Sample ID: 2023-09-25-77
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Verification
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/25/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/13/2023
The quantity of what the sample constitutes: 170
A brief description of the sample: AB536A Amer Brace Bolt
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Acrow
Material Information
Rocap Number(s):
Heat Number(s): NA
Nut Mfg. Lot Number(s): AB536A
Washer Mfg. Lot Number(s): AB536A
Bolt Specification: ASTM A325
Bolt Length(s): 3.5
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 1-8
Bolt Mfg. Lot Number: AB536A
Rocap Test Requirement(s): no
Lubricant Requirements(s): yes
Washer Inner Diameter(s):
Test Results
