Sample Record for 2019-06-13-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211775 DEA: 024E6504 EFIS: 0212000012
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-R52.5/88.4
Work Description: WIDEN BRIDGES,POLYESTER CONC OVERLAY,COLD PLANE AC PVMT,HMA,GUARDRAIL
Location Description: SISKIYOU COUNTY NEAR SEIAD VALLEY AT VARIOUS LOCATIONS FROM 0.1 MILE WEST OF THOMPSON CREEK BRIDGE TO 0.2 MILE EAST OF BEAVER CREEK BRIDGE
Contractor Name: J.F. Shea Construction, Inc
Contractor Address: 17400 Clearcreek Road, Redding, CA 96001
Resident Engineer: Mark Loader Structure Rep.: Robert Thompson
Sample Information
DIME Sample ID: 2019-06-13-6
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 06/13/2019
Date that the sample was received by the laboratory/organization performing the testing: 06/18/2019
The quantity of what the sample constitutes: 494
A brief description of the sample: A325 Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Nucor
Material Information
Rocap Number(s): 415844A
396618A
805830
392621A
Heat Number(s):
Nut Mfg. Lot Number(s): 415206A
Washer Mfg. Lot Number(s): 309017
Bolt Specification: A325
Bolt Length(s): 2-1/4", 2-3/4", 3", 3-1/4"
Nut Specification: A563 Gr. DH
Washer Specification: F436
Finish: Hot Dipped Galvanized
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: 415844A
396618A
805830
392621A
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test Results
