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Sample Record for 2020-05-27-4


Project Information

Project ID: 214601 DEA: 041J5694 EFIS: 0419000313 QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-0.0/21.8
Work Description: Barrier modifications, overhead signs, freeway lighting and electronic toll system components
Location Description: SANTA CLARA AND SAN MATEO COUNTIES FROM 0.3 MILE NORTH OF SAN ANTONIO ROAD TO 0.3 MILE SOUTH OF GRAND AVENUE INTERCHANGE
Contractor Name: KIEWIT INFRASTRUCTURE COMPANY Contractor Address: 1301 SHOREWAY RD, SUITE 275
Resident Engineer: Scott McCrank Structure Rep.: Pinell, Tyler

Sample Information

DIME Sample ID: 2020-05-27-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Office of Structural Materials Field Laboratory
Sample Organization Contact: 7146885366
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 05/27/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/27/2020
The quantity of what the sample constitutes: 339
A brief description of the sample: 2.5" D.E. Anchor Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Rocap Number(s): N/A
Heat Number(s): 201332 3066493 293079
Nut Mfg. Lot Number(s): W3560
Washer Mfg. Lot Number(s): D079692
Bolt Specification: ASTM F1554 Gr55
Bolt Length(s): 60"
Nut Specification: ASTM 194 Gr.2H
Washer Specification: ASTM F436
Finish: HDG/Black
Diameter/Size: 2.5
Bolt Mfg. Lot Number: Not Provided
Rocap Test Requirement(s): No
Lubricant Requirements(s): Yes