Sample Record for 2020-08-03-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212501 DEA: 022E4804 EFIS: 0200000586
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96,263-103.1/103.6,56.8/57.2
Work Description: BRIDGE REPLACEMENT
Location Description: SISKIYOU COUNTY ABOUT 8 MILES NORTH OF YREKA ON ROUTE 96 FROM 0.5 MILE WEST TO 0.2 MILE EAST OF ROUTE 263 AND ON ROUTE 263 FROM 0.3 MILE NORTH OF SHASTA RIVER BRIDGE #02-0014 TO ROUTE 96
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Nicole Mallory Structure Rep.: Andy O'Sullevan
Sample Information
DIME Sample ID: 2020-08-03-3
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: 08/03/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 87/87/174
A brief description of the sample: 1/2" x 3-1/2" A325 bolts, 1/2" A563-DH nuts and 1/2" F436 washers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS Lindon UT
Material Information
Rocap Number(s): TT0131087
Heat Number(s): bolts - 20495460, nuts - 20650010, washers - 190394
Nut Mfg. Lot Number(s): L511Q1
Washer Mfg. Lot Number(s): 957-190394
Bolt Specification: A325
Bolt Length(s): 3-1/2"
Nut Specification: A563-DH
Washer Specification: F436
Finish: HDG - all
Diameter/Size: 1/2"
Bolt Mfg. Lot Number: G9825
Rocap Test Requirement(s): Yes
Lubricant Requirements(s): none
Test Results
