*Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Sample Record for 2017-07-18-8
Project ID: 211948 DEA: 073W2204 EFIS: 0716000011 QA Service Level: 1
Work Description: REPLACE BRIDGE APPROACH SLABS AND REHABILITATE DECKS.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AND GLENDALE FROM NORTH CONNECTOR OVERCROSSING TO HONOLULU AVENUE UNDERCROSSING
Contractor Name: West Coast Structures, Inc. Contractor Address: 6005 Tyler St.
Resident Engineer: Patricia Amadi Structure Rep.: Pimienta, Adriana
DIME Sample ID: 2017-07-18-8
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 07/18/2017
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1
A brief description of the sample: Threaded Bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Heat Number(s): 405414
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: ASTM 307
Bolt Length(s): 3'-8"
Nut Specification: N/A
Washer Specification: N/A
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):