Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214399 DEA: 044Q3404 EFIS: 0419000383
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-580-1.3, 1.30
Work Description: Near San Quentin, in the Richmond-San Rafael Bridge, heat straightening truss chords
Location Description: Near San Quentin, in the Richmond-San Rafael Bridge
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 Fourth St., Berkeley, CA 94710
Resident Engineer: Bezhad Halali Structure Rep.: Unknown
DIME Sample ID: 2019-11-13-19
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: 24
A brief description of the sample: 3/4" F436 Hot Dip galv bevel washers
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name: unknown
The fabricator/manufacturer/facility name: Bay Bolt
Rocap Number(s):
Heat Number(s): A172357
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s): D4748
Bolt Specification: none
Bolt Length(s): Unknown
Nut Specification: none
Washer Specification: F436 HDG Bevel washer
Finish: Hot Dip Galv.
Diameter/Size: 3/4"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
