Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215113 DEA: 021J2404 EFIS: 0220000048
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA,VAR-273,Var-Var
Work Description: PSPS Streetlight Backing plates-Steel Cantilever structure for solar panels
Location Description:
Contractor Name: CAL ELECTRO, INC.
Contractor Address: 3710 Electro Way, Redding, CA 96002
Resident Engineer: Michael Zdenek Structure Rep.: Unknown
DIME Sample ID: 2020-09-29-6
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/29/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 32
A brief description of the sample: 1" Domestic HDG ASTM F436 Type 1 hardened washers
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Portland Bolt
Rocap Number(s):
Heat Number(s): 208374
Nut Mfg. Lot Number(s): NA
Washer Mfg. Lot Number(s): 0320-424
Bolt Specification: NA
Bolt Length(s): NA
Nut Specification: NA
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 1"
Bolt Mfg. Lot Number: NA
Rocap Test Requirement(s):
Lubricant Requirements(s): NA
