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Sample Record for 2020-05-27-5

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

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: San Mateo US 101 Express Lanes North
Location Description:
Contractor Address: 1301 SHOREWAY RD, SUITE 275, BELMONT, CA 94402
Resident Engineer: Douglas Inori Structure Rep.: Tyler Pinell

Sample Information

DIME Sample ID: 2020-05-27-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
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: 9
A brief description of the sample: 2.25" D.E. Anchor Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Madden Bolt

Material Information

Rocap Number(s): N/A
Heat Number(s): 58041029 188206 294167
Nut Mfg. Lot Number(s): W27520
Washer Mfg. Lot Number(s): D080450
Bolt Specification: ASTM F1554 Gr55
Bolt Length(s): 40"
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

Test Results