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Sample Record for 2020-11-18-5

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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: 2020-11-18-5
TL Number from the TL Form: TL-102
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: 11/18/2020
Date that the sample was received by the laboratory/organization performing the testing: 11/18/2020
The quantity of what the sample constitutes: 39
A brief description of the sample: A325 Bolt Assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name: OHSS S63
The fabricator/manufacturer/facility name: Structural and Steel Products

Material Information

Rocap Number(s): 430807A
Heat Number(s): 100201805, DL19105173, 180226
Nut Mfg. Lot Number(s): 431190A
Washer Mfg. Lot Number(s): 317500
Bolt Specification: ASTM A325
Bolt Length(s): 2-1/4"
Nut Specification: A563
Washer Specification: F436
Finish: Mech Galv-B695
Diameter/Size: 3/4"x2-1/4"
Bolt Mfg. Lot Number: 430807A
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Results