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: 2022-11-10-9
TL Number from the TL Form: C926091
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 TM6 - Steel Check Sample Plate
Sample Taken Date: 11/10/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 16 ea
A brief description of the sample: 37.6 Machined anchor head
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name: Gilman Pedstrian Overcrossing
The fabricator/manufacturer/facility name: Schwager Davis
