Sample Record for 2017-11-06-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211889 DEA: 08368514 EFIS: 0813000077
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-81.1/87.5&177.3/181.1
Work Description: CONSTRUCT AIF AND DEMOLISH EXISTING AIF IN YERMO
Location Description: SAN BERNARDINO COUNTY FROM 0.6 MILE NORTH OF YERMO ROAD OVERCROSSING TO 1.0 MILE SOUTH OF MINNEOLA ROAD OVERCROSSING AND FROM 1.2 MILE NORTH OF NIPTON ROAD OVERCROSSING TO 0.5 MILE SOUTH OF YATES WELL ROAD OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 38000 Monroe St, Indio, CA 92203
Resident Engineer: Darcy Davis Structure Rep.: Luis Negrete
Sample Information
DIME Sample ID: 2017-11-06-1
TL Number from the TL Form: C719147
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: 11/06/2017
Date that the sample was received by the laboratory/organization performing the testing: 11/07/2017
The quantity of what the sample constitutes: 1
A brief description of the sample: 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): n/a
Heat Number(s): 3070316
Nut Mfg. Lot Number(s): Dyson lot DDTL, DDBM
Washer Mfg. Lot Number(s): n/a
Bolt Specification: F1554 Gr.55
Bolt Length(s): 4'-5"
Nut Specification: A563-DH
Washer Specification: F436
Finish: HDG/plain
Diameter/Size: 1 1/2" x 4'-5"
Bolt Mfg. Lot Number: n/a
Rocap Test Requirement(s): none
Lubricant Requirements(s): none
Test Results
