Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214228 DEA: 120N4904 EFIS: 1214000050
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-91-R12.5/R13.9
Work Description: VEHICLE ENFORCEMENT FACILITY IMPROVEMENT AT PERALTA WEIGH STATION.
Location Description: ORANGE COUNTY IN ANAHEIM FROM 1.0 MILE EAST OF ROUTE 91/90 SEPARATION TO 0.5 MILE WEST OF WEIR CANYON ROAD UNDERCROSSING
Contractor Name: SPECTRUM CONSTRUCTION GROUP, INC.
Contractor Address: 32 EDELMAN, IRVINE, CA 92618
Resident Engineer: Dat Pham Structure Rep.: Bijan Ronagh-Langroodi
DIME Sample ID: 2020-09-14-9
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: Quality Assurance
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: 25
A brief description of the sample: 5/8" x 2" bolts
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bristol Machine
Rocap Number(s):
Heat Number(s): 10620770
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): N/A
Bolt Specification: ASTM A325
Bolt Length(s): 2"
Nut Specification: N/A
Washer Specification: N/A
Finish: Black
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: L073L1
Rocap Test Requirement(s):
Lubricant Requirements(s):
