Sample Record for 2019-04-17-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213788 DEA: 120Q5204 EFIS: 1217000057 MINOR: 12A1741
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-12,133-8.29
Work Description: Remove seven electroliers, install high-mast lighting ,asphalt and optical speed bar and Install safety lighting & optical speed bar
Location Description: Route 133
Contractor Name: Alfaro Communication
Contractor Address: 15614 South Atlantic, Compton, CA 90221
Resident Engineer: Moussa Essayli Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2019-04-17-4
TL Number from the TL Form: C720609
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: 04/17/2019
Date that the sample was received by the laboratory/organization performing the testing: 04/19/2019
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:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: EDSCO Fasteners
Material Information
Rocap Number(s): none
Heat Number(s): 3084898, 188194, 176419, 177682
Nut Mfg. Lot Number(s): Dyson - DDYO, DDYC
Washer Mfg. Lot Number(s): Wrought 308878
Bolt Specification: F1554 Gr. 55
Bolt Length(s): 4'-5"
Nut Specification: A194 2H
Washer Specification: F436 HDG
Finish: HDG and plain
Diameter/Size: 2" x 4'-5"
Bolt Mfg. Lot Number: EDSCO no lot number
Rocap Test Requirement(s): none
Lubricant Requirements(s): yes
Test Results