Sample Record for 2019-10-31-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214141 DEA: 081J1204 EFIS: 0817000208
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15,91,215-Var
Work Description: REMOVE, PREPARE AND FURNISH POLYESTER CONCRETE OVERLAY.
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS
Contractor Name: J. FRANCIS COMPANY
Contractor Address: 16197 Krameria Ave., Riverside, CA 92504
Resident Engineer: Xavier Avila Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2019-10-31-2
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: 10/31/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 24
A brief description of the sample: A325 HDG Rocap Assembiy
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CK Johnson
Material Information
Rocap Number(s): 424370B
Heat Number(s): 100896901
Nut Mfg. Lot Number(s): 406871A
Washer Mfg. Lot Number(s): C6542D
Bolt Specification: A325
Bolt Length(s): 2-1/4"
Nut Specification: A563 Grade DH
Washer Specification: F436
Finish: HDG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: 424370B
Rocap Test Requirement(s):
Lubricant Requirements(s): Lubed
Test Results
