Sample Record for 2019-02-05-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212687 DEA: 06442544 EFIS: 0612000175
QA Service Level: 1
Work Description: CONVERT 2-LANE TO 4-LANE CONVENTIONAL HIGHWAY.
Location Description: KERN COUNTY NEAR LOST HILLS FROM 1.0 MILE EAST OF LOST HILLS ROAD TO 0.7 MILE EAST OF ROUTE 46/5 SEPARATION
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Amarjit Dhaliwal Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2019-02-05-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 227-7263
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 02/05/2019
Date that the sample was received by the laboratory/organization performing the testing: 02/08/2019
The quantity of what the sample constitutes: 4
A brief description of the sample: F1554 Grade 55 HDG Anchor Bolts
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
The fabricator/manufacturer/facility name: Platte Anchor Bolt
Rocap Number(s): N/A
Heat Number(s): 3051299
Nut Mfg. Lot Number(s): 21979-6213174804
Washer Mfg. Lot Number(s): 292683
Bolt Specification: 1554 Gr.55
Bolt Length(s): 24", 26 1/4"
Nut Specification: A563
Washer Specification: F436
Bolt Mfg. Lot Number: 3051299
Rocap Test Requirement(s):