Sample Record for 2019-04-23-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213074 DEA: 044G8904 EFIS: 0413000059
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-580-5.8
Work Description: BIDGE SEISMIC RETROFIT
Location Description: CONTRA COSTA COUNTY IN RICHMOND AT SCOFIELD AVENUE UNDERCROSSING
Contractor Name: BROSAMER & WALL, INC.
Contractor Address: 1777 Oakland Blvd., Suite 300, Walnut Creek, CA 94596
Resident Engineer: Jason Trinh Structure Rep.: Eric Urmeneta
Sample Information
DIME Sample ID: 2019-04-23-1
TL Number from the TL Form:
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: 04/23/2019
Date that the sample was received by the laboratory/organization performing the testing: 04/26/2019
The quantity of what the sample constitutes: 12
A brief description of the sample: 7/8 A325 Bolts, nuts and washers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CK Johnson Industries
Material Information
Rocap Number(s): 87C300BA30M
Heat Number(s): DL1703744,DL15107150,174929
Nut Mfg. Lot Number(s): 374243A
Washer Mfg. Lot Number(s): D4936
Bolt Specification: A325
Bolt Length(s): 3"
Nut Specification: A563 Hvy HX
Washer Specification: F436
Finish: MG
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: 404238A
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test Results
