Sample Record for 2022-03-18-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215371 DEA: 042W1204 EFIS: 0421000139
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC,CC/MRN-580-6.9/7.8, 6.9, 7.8, 02, 5
Work Description: REPLACEMENT OF GUSSET PLATES AT VARIOUS LOCATIONS
Location Description: Richmond San Rafael Bridge
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510
Resident Engineer: Behzad Halali Structure Rep.: William Sommer
Sample Information
DIME Sample ID: 2022-03-18-3
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: 03/18/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 24
A brief description of the sample: All-Thread Rod
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Liberty Bolt
Material Information
Rocap Number(s): n/a
Heat Number(s): 11722380
Nut Mfg. Lot Number(s): n/a
Washer Mfg. Lot Number(s): n/a
Bolt Specification: ASTM A354-BD
Bolt Length(s): 71"
Nut Specification: n/a
Washer Specification: n/a
Finish: Hot Dipped Galvanized
Diameter/Size: 1 1/8"
Bolt Mfg. Lot Number: n/a
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test Results
