Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215255 DEA: 040A7714 EFIS: 0420000287
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-80-6.4-6.6
Work Description: CONSTRUCT PEDESTRIAN OVERCROSSING BRIDGE AND RETAINING WALLS. GILMAN INTERCHANGE IMPROVEMENTS
Location Description: ALAMEDA COUNTY IN BERKELEY FROM 0.6 MILE NORTH OF UNIVERSITY AVENUE OVERCROSSING TO 0.1 MILE SOUTH OF GILMAN STREET UNDERCROSSING
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Rebecca Perng Structure Rep.: Eric Urmeneta
DIME Sample ID: 2022-06-24-45
TL Number from the TL Form: B391-06-10-2022
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Quality Assurance
Type of Material: SMTL TM6 - Ductile Iron Cast Samples
Sample Taken Date: 06/24/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/06/2022
The quantity of what the sample constitutes: 24,200 lbs
A brief description of the sample: Forged Hanger Assembly Pin
From where was the sample collected: Fabricator
Laboratory sample identification: CODE ZZN13
Structure unique identifier: 33-6674
Structure name: Gilman St POC
The fabricator/manufacturer/facility name: Dyson Forge Painesville OH
Heat Number (s): S3333
Part Number (s): ZZN13
Material Specification: N/A
Grades: N/A
Metal Foundry Manufacturer (Mill): Ellwood National Steel
Prestressing Manufacturer: Not applicable
