Sample Record for 2017-06-28-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211371 DEA: 120H2434 EFIS: 1214000038
QA Service Level: 1
DIST-CO-RTE-PM: 12-LA,ORA-91-R20.6/R20.7,R0.0/R2.8
Work Description: INSTALL FIBER OPTIC CABLE & CCTVS
Location Description: ORANGE AND LOS ANGELES COUNTIES IN LA PALMA, BUENA PARK AND CERRITOS FROM 0.1 MILE WEST OF LOS ANGELES COUNTY LINE TO STANTON AVENUE UNDERCROSSING
Contractor Name: YAKAR
Contractor Address: 689 E. SAN BERNARDINO RD. , COVINA, CA 91723
Resident Engineer: Danh Thai Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2017-06-28-1
TL Number from the TL Form: Unknown
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: 06/28/2017
Date that the sample was received by the laboratory/organization performing the testing: 06/28/2017
The quantity of what the sample constitutes: 1
A brief description of the sample: 2 1/4 x 54 anchor bolt assembly
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: EDSCO
Material Information
Rocap Number(s): none
Heat Number(s): A163193, 235222, 190821, 3064247
Nut Mfg. Lot Number(s): ameribolt W1741, Dyson DCRO
Washer Mfg. Lot Number(s): HT 235222
Bolt Specification: F1554 gr.55
Bolt Length(s): 54
Nut Specification: A194-2H
Washer Specification: F436
Finish: HDG/plain
Diameter/Size: 2 1/4
Bolt Mfg. Lot Number: HT- 3064247
Rocap Test Requirement(s): none
Lubricant Requirements(s):
Test Results
