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Sample Record for 2020-01-15-9


Project Information

Project ID: 213737 DEA: 07289104 EFIS: 0700021123 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-11.9/13.2
Work Description: Rehabilitate the existing Commercial Vehicle Enforcement Facility.
Location Description: LOS ANGELES COUNTY IN CARSON FROM DEL AMO BOULEVARD OVER CROSSING TO VERMONT AVENUE (190TH) UNDER CROSSING.
Contractor Name: D W Powell Construction, Inc. (Brandon Hochhauser) Contractor Address: 8555 Banana Avenue
Resident Engineer: Samuel Gallardo Structure Rep.: Contreras Jr, Bernabe

Sample Information

DIME Sample ID: 2020-01-15-9
TL Number from the TL Form: TL101 719046
Sample Submitted By Organization: CT QASI - Sacramento Field Laboratory
Sample Organization Contact: (916) 227-7263
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 01/15/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 70 nuts
A brief description of the sample: 1 1/4" ASTM A194 Heavy Hex Nut Grade 2H, HDG
From where was the sample collected: Fabricator
Laboratory sample identification: Lot 1
Structure unique identifier:
Structure name: Canopy

Material Information

Rocap Number(s):
Heat Number(s): 144235
Nut Mfg. Lot Number(s): 19298-144235
Washer Mfg. Lot Number(s): n/a
Bolt Specification: n/a
Bolt Length(s): n/a
Nut Specification: A194 Heavy Hex Nut Grade 2H
Washer Specification: n/a
Finish: Hot Dipped Galvanized ASTM A-153
Diameter/Size: 1 1/4"
Bolt Mfg. Lot Number: n/a
Rocap Test Requirement(s):
Lubricant Requirements(s):