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Sample Record for 2018-03-19-4

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 212795 DEA: 05937704 EFIS: 0514901244 Permit Numbers: 05176UB0132 QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-68-4.04
Work Description: Install a water pipeline bridge including a 36 inch diameter steel casing
Location Description: County of Monterey
Contractor Name: Garney Construction Company
Contractor Address: 1110 Airport Rd, Monterey, CA 93940
Resident Engineer: Ignacio Saavedra Structure Rep.: David Galarza

Sample Information

DIME Sample ID: 2018-03-19-4
TL Number from the TL Form: C836243
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 03/19/2018
Date that the sample was received by the laboratory/organization performing the testing: 03/26/2018
The quantity of what the sample constitutes: Two Threaded Rod Assemblies
A brief description of the sample: Allthread anchor rod assembly
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Coastal Fabrication

Material Information

Rocap Number(s):
Heat Number(s): 62143718 8196752
Nut Mfg. Lot Number(s): 32N9D
Washer Mfg. Lot Number(s):
Bolt Specification: A722
Bolt Length(s): 5'
Nut Specification: A29
Washer Specification: n/a
Finish: HDG
Diameter/Size: 1-1/4"
Bolt Mfg. Lot Number: 32N9D
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Results