Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214590 DEA: 043G4744 EFIS: 0412000074
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN,MRN-580-6.9/7.8,0.0/2.5
Work Description: CLEAN AND PAINT STRUCTURAL STEEL BRIDGE.
Location Description: CONTRA COSTA AND MARIN COUNTIES IN RICHMOND AND SAN RAFAEL FROM 0.8 MILE WEST OF TOLL PLAZA TO 0.1 MILE EAST OF MAIN STREET
Contractor Name: Allied Painting, INC.
Contractor Address: 4 Larwin Road, Cherry Hill, NJ08034
Resident Engineer: Behzad Halali Structure Rep.: William Sommer
DIME Sample ID: 2021-05-12-7
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: 05/12/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 700
A brief description of the sample: Washer
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name: San Rafael Bridge
The fabricator/manufacturer/facility name: Technical Stamping
Rocap Number(s):
Heat Number(s): 197564
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s): 257096
Bolt Specification: A325
Bolt Length(s):
Nut Specification: 563
Washer Specification: F-436-10
Finish: Hdg
Diameter/Size: 1.0"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
