Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210077 DEA: 043G9204 EFIS: 0414000507 COOP: 042565
QA Service Level: 2
DIST-CO-RTE-PM: 04-ALA-880-9.5/10.0
Work Description: Conversion of HOV Lanes to Express Lanes on I-880 ; Installation of the necessary Backhaul Communicaiton Network from Rte 237 to Hegenberger Road
Location Description: Between Rte 237 and Lewelling Road and I-880 SB between Rte 237 and Hegenberger Road.
Contractor Name: Bay Cities Paving & Grading
Contractor Address: 1450 Civic Ct. BLDG B #400, Concord CA, 94520
Resident Engineer: Vincent Tang Structure Rep.: Hissen
DIME Sample ID: 2018-07-12-7
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Verification
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 07/12/2018
Date that the sample was received by the laboratory/organization performing the testing: 07/12/2018
The quantity of what the sample constitutes: 2219
A brief description of the sample: Overhead Sign Bolting
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Structural and Steel Products
Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: A325
Bolt Length(s): Unknown
Nut Specification: A563
Washer Specification: F436
Finish:
Diameter/Size: Unknown
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
