Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2025-09-26-3

Project Information

Project IdentifiersProject ID: 1000611
DEA: 120R32U4
EFIS: 1222000054
DIST-CO-RTE-PM12-ORA-55-0.2/R17.8
Award Date02/07/2025
Closeout DateNot set
Work DescriptionCOLD PLANE, PLACE RHMA, REPLACE CB, SIGNS AND MODIFY LIGHTING SYSTEM.
Location DescriptionORANGE COUNTY FROM 0.1 MILE SOUTH OF ROUTE 55/1 SEPARATION IN NEWPORT BEACH TO ROUTE 55/91 SEPARATION IN ANAHEIM
QA Service Level1 (Verified on 09/30/2024)

Sample Information

Sample Taken Date09/26/2025 Sample Unique Key3
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testingNot set
Sample typeQuality Assurance A brief description of the sampleAnchor bolt assembly
The quantity of what the sample constitutes1 lot of 49 From where was the sample collectedSource
First name of sampler or witnessed bykent Last name of sampler or witnessed byallen
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameHalo Structural Products Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name Bid ItemNot set

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)
Heat Number(s) Nut Mfg. Lot Number(s)
Washer Mfg. Lot Number(s) Bolt Specificationf1554
Bolt Length(s) Nut Specificationa563
Washer SpecificationF436 Finish
Diameter/Size Bolt Mfg. Lot Number
Rocap Test Requirement(s) Lubricant Requirements(s)
Washer Inner Diameter(s)

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedDate AddedVerified?Release DateTest CommentsPrivacy LevelActions
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