Sample Record for 2022-08-23-13
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215788 DEA: 101C7904 EFIS: 1016000046
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-5-0.4
Work Description: BUILDING WORK.
Location Description: MERCED COUNTY 0.4 MILE NORTH OF THE FRESNO COUNTY LINE AT THE JOHN "CHUCK" ERRECA SAFETY ROADSIDE REST AREA
Contractor Name: Walsh Construction Company II, LLC (Walsh) - Bryce Frederick
Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520
Resident Engineer: Zubair Anwar Structure Rep.: Ramandeep "Raman" Guraya
Sample Information
DIME Sample ID: 2022-08-23-13
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: 08/23/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 288 assemblies
A brief description of the sample: ASTM A1554-36 Assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mike Owens Fabrication
Material Information
Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s): 465441B
Washer Mfg. Lot Number(s): 0122-206
Bolt Specification: ASTM F1554 - 36
Bolt Length(s): 17"
Nut Specification: ASTM A563-DH
Washer Specification: ASTM F436
Finish: Black
Diameter/Size: 1"
Bolt Mfg. Lot Number: 1202037822961
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test Results
