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Sample Record for 2018-09-17-8

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

Project Information

Project ID: 212726 DEA: 030F3514 EFIS: 0316000080 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51,99-VAR
Work Description: ROADWAY EXCAVATION, HOT MIX ASPHALT AND MODIFY ELECTRICAL SYSTEM; SOLDIER PILES; CONCRETE RETAINING WALL
Location Description: SACRAMENTO COUNTY FROM 0.5 MILE SOUTH OF COSUMNES RIVER BOULEVARD TO 0.2 MILE EAST OF ARDEN WAY UNDERCROSSING
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: 1450 Civic Ct. BLDG B #400, Concord CA, 94520
Resident Engineer: Sushma Lee Structure Rep.: Brent Bullard

Sample Information

DIME Sample ID: 2018-09-17-8
TL Number from the TL Form: C874455
Sample Submitted By Organization: CT QASI - Sacramento Field Laboratory
Sample Organization Contact: (916) 227-7263
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/17/2018
Date that the sample was received by the laboratory/organization performing the testing: 09/19/2018
The quantity of what the sample constitutes: 33
A brief description of the sample: F1554 Anchor Bolt Assembly
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Portland Bolt

Material Information

Rocap Number(s):
Heat Number(s): PL17100076
Nut Mfg. Lot Number(s): 28588-S-6214658903
Washer Mfg. Lot Number(s): 350118208020
Bolt Specification: F1554
Bolt Length(s): 10.5''
Nut Specification: A563
Washer Specification: A36/50
Finish: HDG
Diameter/Size: 7/8''
Bolt Mfg. Lot Number: B1121026
Rocap Test Requirement(s): None
Lubricant Requirements(s):

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.