Sample Record for 2019-11-13-11
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214015 DEA: 034H9504 EFIS: 0319000123
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,SAC/YOL-12,160-0-0.4/26.3-26.4, Var, various
Work Description: Repair and modernize electromechanical bridge.
Location Description: In Sacramento County at four bridges.
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Masoud Saed Structure Rep.: Rusty D'Anna
Sample Information
DIME Sample ID: 2019-11-13-11
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: 11/13/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/19/2019
The quantity of what the sample constitutes: 40
A brief description of the sample: 5/8" x 2" A325 TC bolt assemblies- Mech Galv
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name: unknown
The fabricator/manufacturer/facility name: Bay Bolt
Material Information
Rocap Number(s): 6189-02
Heat Number(s): 10568810 bolt
75072730- nut
9515105- washer
Nut Mfg. Lot Number(s): 29243-75072730 Unytite
Washer Mfg. Lot Number(s): D6157 Prestige
Bolt Specification: A325 Type 1 Tension control
Bolt Length(s): 2"
Nut Specification: A563 DH
Washer Specification: F436 M/G
Finish: Mechanically Galvanized
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: 29237-10568810 Unytite mfg
Rocap Test Requirement(s): yes
Lubricant Requirements(s): yes
Test Results
