Sample Record for 2022-10-13-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405,73,405,605-9.3/24.3
Work Description: (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP.
Location Description: Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2
Contractor Name: OC 405 Partners
Contractor Address: 3100 W Lake Center Dr, Santa Ana, CA 92704
Resident Engineer: Hank Alonso (reports) Structure Rep.: Alex Angha (reports)
Sample Information
DIME Sample ID: 2022-10-13-4
TL Number from the TL Form:
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 TM3 - Fastener Assembly
Sample Taken Date: 10/13/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/13/2022
The quantity of what the sample constitutes: 2348 Nuts
A brief description of the sample: A563 Grade DH Nut w/ Collar
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ace Fence Company
Material Information
Rocap Number(s):
Heat Number(s): DL20104497
Nut Mfg. Lot Number(s): 448953B
Washer Mfg. Lot Number(s):
Bolt Specification: NA
Bolt Length(s):
Nut Specification: A563 DH
Washer Specification: NA
Finish: HDG
Diameter/Size: 0.75
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s): Green
Test Results
