Sample Record
Owner Lab
- CT HQ - QASI Sacramento Field Office
DIME Sample ID 2026-03-30-21
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Project Information
| Project Identifiers | Project ID: 1000785 DEA: 081J3204 EFIS: 0818000017 COOP: NONE |
|---|---|
| DIST-CO-RTE-PM | 08-RIV-74-17.8 |
| Award Date | 05/29/2025 |
| Closeout Date | Not set |
| Work Description | BUILDING WORK, WROUGHT IRON FENCE, HOT MIX ASPHALT, & AGGREGATE BASE. |
| Location Description | RIVERSIDE COUNTY NEAR LAKE ELSINORE AT LAKE ELSINORE MAINTENANCE STATION AT 18745 CONARD AVENUE |
| QA Service Level | 1 (Verified on 01/13/2025) |
Sample Information
| Sample Taken Date | 03/30/2026 | Sample Unique Key | 21 |
|---|---|---|---|
| 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 testing | Not set |
| Sample type | Quality Assurance | A brief description of the sample | 5/8” x 5” ASTM F1554 GR36 Galv. DH Heavy Hex Nut ASTM A563 Flat washer ASTM F436 |
| The quantity of what the sample constitutes | 10 pcs | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | Joaquin | Last name of sampler or witnessed by | Moreno |
| Title of sampler | Quality Assurance Inspector | Telephone number of sampler | 9095268064 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | AB Threading inc. | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | L161-020-26 | Structure unique identifier | |
| Structure name | Building Work | Bid Item | 101 - BUILDING WORK |
Material Information
| Material Type | SMTL TM3 - Fastener Assembly | Rocap Number(s) | NA, Anchor Bolts |
|---|---|---|---|
| Heat Number(s) | Anchor Bolts | Nut Mfg. Lot Number(s) | W000278671 |
| Washer Mfg. Lot Number(s) | 12511080 | Bolt Specification | ASTM F1554 |
| Bolt Length(s) | 5" | Nut Specification | ASTM A563 |
| Washer Specification | ASTM F436 | Finish | NA |
| Diameter/Size | 5/8" | Bolt Mfg. Lot Number | 1000221652 |
| Rocap Test Requirement(s) | Anchor Bolts | Lubricant Requirements(s) | Anchor Bolts Nut green wax |
| Washer Inner Diameter(s) | NA |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Date Added | Verified? | Release Date | Test Comments | Privacy Level | Actions |
|---|---|---|---|---|---|---|---|---|---|
| No results found. | |||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| 08-1J3204_DOCS_L161-020-26_3-30-26_6496_DIME#2026-03-20-21 | 04/01/2026 | Info |