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Sample Record for 2019-11-14-9


Project Information

Project ID: 213724 DEA: 040K8404 EFIS: 0416000148 QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-680-13.9/22.7
Work Description: INSTALL FREEWAY SAFETY LIGHTING
Location Description: CONTRA COSTA COUNTY AT VARIOUS LOCATIONS FROM OLYMPIC BOULEVARD TO ARTHUR ROAD
Contractor Name: BAY CITIES PAVING AND GRADING INC Contractor Address: PO Box 6227
Resident Engineer: Amir Hatefi Structure Rep.: Parecadan, John

Sample Information

DIME Sample ID: 2019-11-14-9
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Bay Area Field Laboratory
Sample Organization Contact: (707) 649-5453
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 11/14/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 5ea, 12ea
A brief description of the sample: A325 Bolt Assemblies
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: A325
Bolt Length(s):
Nut Specification: A563
Washer Specification: F436
Finish: Mechanically Galvanized
Diameter/Size: 3/4" x 1-3/4" and 1" x 5"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s): Blue