Sample Record for 2024-05-20-98
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994859 DEA: 021H5904 EFIS: 0216000025
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-43.5,57.0
Work Description: REPLACE CULVERTS WITH BRIDGES, STREAMBED RESTORATION, & LANDSCAPING.
Location Description: SISKIYOU COUNTY AT AND NEAR HAPPY CAMP AT 0.8 MILE WEST OF GORDON\\\\'S FERRY ROAD AND AT PORTUGUESE CREEK
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: 17400 CLEAR CREEK ROAD, REDDING, CA 96001
Resident Engineer: Nicholas Riddle Structure Rep.: Nicolas Jimenez
Sample Information
DIME Sample ID: 2024-05-20-98
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Verification
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 05/20/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/29/2024
The quantity of what the sample constitutes: 279
A brief description of the sample: Acrow part AB546
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Acrow Bridge
Material Information
Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: ASTM A325
Bolt Length(s):
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: ASTM A325 HDG
Diameter/Size: ¾” x 2 7/8”
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test Results
