Sample Record for 2019-05-02-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213846 DEA: 041J5614 EFIS: 0419000117
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-0.0/6.7
Work Description: Barrier modifications, overhead signs, freeway lighting and electronic toll system components
Location Description: SANTA CLARA AND SAN MATEO COUNTIES IN PALO ALTO AND REDWOOD CITY FROM 0.3 MILE NORTH OF SAN ANTONIO ROAD TO WHIPPLE AVENUE OVERCROSSING
Contractor Name: KIEWIT INFRASTRUCTURE WEST CO
Contractor Address: 390 Bridge Parkway Suite 210, Redwood City, CA 94065
Resident Engineer: Doug Inori Structure Rep.: Tyler Pinell
Sample Information
DIME Sample ID: 2019-05-02-3
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: 05/02/2019
Date that the sample was received by the laboratory/organization performing the testing: 05/02/2019
The quantity of what the sample constitutes: 48 ea
A brief description of the sample: 1" x 2.25" A325 Bolt and washer only
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS
Material Information
Rocap Number(s): none
Heat Number(s): Bolt- 20391740
Washer- 532619
Nut Mfg. Lot Number(s): none
Washer Mfg. Lot Number(s): D1862
Bolt Specification: A325
Bolt Length(s): 2 1/4"
Nut Specification: none
Washer Specification: F436
Finish: Mechanically Galvanized
Diameter/Size: 1"
Bolt Mfg. Lot Number: BM0196
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test Results
