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Sample Record for 2019-10-29-63

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 210837 DEA: 080J0804 EFIS: 0800000283 COOP: 081625 QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-34.7/51.6
Work Description: (Alternative Delivery) DESIGN-BUILD OF THE INTERSTATE 15 EXPRESS LANES PROJECT
Location Description: Riverside County and SBD-15-0.0/1.3
Contractor Name: Skanska-Ames, Joint Venture
Contractor Address: 1801 California Avenue, Corona, CA 92881
Resident Engineer: Roy Fisher (reports) Structure Rep.: Roy Fisher

Sample Information

DIME Sample ID: 2019-10-29-63
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 10/29/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/05/2019
The quantity of what the sample constitutes: 12
A brief description of the sample: A325 MG Fastener Assembly
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS

Material Information

Rocap Number(s): TT0121428
Heat Number(s): 20403620
Nut Mfg. Lot Number(s): 29747
Washer Mfg. Lot Number(s): D7245
Bolt Specification: A325 MG
Bolt Length(s): 1"x6"
Nut Specification: A563 DH
Washer Specification: F436
Finish: MG
Diameter/Size: Unknown
Bolt Mfg. Lot Number: BM0269
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Results