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Sample Record for 2020-09-14-4

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

Project Information

Project ID: 213741 DEA: 07325704 EFIS: 0716000089 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-1.7
Work Description: BUILDING CONSTRUCTION IN LOS ANGELES COUNTY IN SANTA FE SPRINGS AT 14044 FREEWAY DRIVE.
Location Description: Santa Fe Springs, At 14044 Freeway Drive.
Contractor Name: AWI Builders Inc
Contractor Address: 7831 Paramount Bl, Pico Rivera Ca 90660
Resident Engineer: Mashhur Ali Structure Rep.: Nelson Parada

Sample Information

DIME Sample ID: 2020-09-14-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Retest
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/14/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/18/2020
The quantity of what the sample constitutes: 15
A brief description of the sample: 1 3/4 TC Bolt
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bristol Machine

Material Information

Rocap Number(s):
Heat Number(s): Bolt 100100767
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): N/A
Bolt Specification: ASTM F1852
Bolt Length(s): 1 3/4"
Nut Specification: N/A
Washer Specification: N/A
Finish: Black
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: 31997-100100767
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Results