Sample Record for 2024-04-04-10
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215771 DEA: 09367504 EFIS: 0916000032
QA Service Level: 1
DIST-CO-RTE-PM: 09--5756-NA
Work Description: Building work, hot mix asphalt (type A)
Location Description: IN KERN COUNTY IN TEHACHAPI AT THE TEHACHAPI HIGHWAY MAINTENANCE STATION AT 305 INDUSTRIAL PARKWAY
Contractor Name: BOWE CONTRACTORS INC.
Contractor Address: 609 Bailey Ct, Tehachapi, CA 93561
Resident Engineer: Raj Bharathan Structure Rep.: Alex Naime
Sample Information
DIME Sample ID: 2024-04-04-10
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: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 04/04/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 3,780
A brief description of the sample: 1/2"-13 x 1 3/4" A325 Bolt assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cordova Bolt Inc.
Material Information
Rocap Number(s): N/A
Heat Number(s): Bolt- 100219761
Nut- 1000220291
Washer- 227284
Nut Mfg. Lot Number(s): W000060045
Washer Mfg. Lot Number(s): 0123-593
Bolt Specification: ASTM A325
Bolt Length(s): 1-1/2"
Nut Specification: A563
Washer Specification: F436
Finish: Plain
Diameter/Size: 1/2"
Bolt Mfg. Lot Number: W000043560
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test Results
