Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214102 DEA: 043Q9404 EFIS: 0419000285
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC,CC,MRN-580-6.1/7.8, 0/2.7
Work Description: Emergency joint replacement project
Location Description: Richmond San Rafael Bridge
Contractor Name: O.C Jones & Sons, INC
Contractor Address: 1520 Fourth Street, Berkeley CA 94710
Resident Engineer: Behzad Halali Structure Rep.: David Quintana
DIME Sample ID: 2019-07-11-1
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: 07/11/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 8 ea
A brief description of the sample: A325 TC Bolt Assemblies
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bay Bolt
Rocap Number(s): 1864-01
Heat Number(s):
Nut Mfg. Lot Number(s): 29196-75072040
Washer Mfg. Lot Number(s): D4913
Bolt Specification: A325-TC
Bolt Length(s): 2"
Nut Specification: A563
Washer Specification: F436
Finish:
Diameter/Size: 7/8"-9
Bolt Mfg. Lot Number: 29472-100793828
Rocap Test Requirement(s):
Lubricant Requirements(s):
