Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215421 DEA: 042K9504 EFIS: 0417000057
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-14.4/14.4
Work Description: CONSTRUCT MATERIAL TESTING LABORATORY BUILDING.
Location Description: ALAMEDA COUNTY IN LIVERMORE AT 2201 KITTY HAWK ROAD
Contractor Name: Walsh Construction Company II, LLC (Walsh) - Dominic Fung
Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520
Resident Engineer: Amir-Fardin Sadeghi-Nedjad Structure Rep.: John Parecadan
DIME Sample ID: 2023-07-05-7
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: (510) 774-6009
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 07/05/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 100 pieces
A brief description of the sample: 7/8” x 19” astm F1554 Rg 36 uncoated
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Walsh Construction
Rocap Number(s): Na
Heat Number(s):
Nut Mfg. Lot Number(s): Na
Washer Mfg. Lot Number(s): Na
Bolt Specification: Astm f1554 Gr36
Bolt Length(s): 19”
Nut Specification: Na
Washer Specification: Na
Finish: Uncoated
Diameter/Size: 7/8”
Bolt Mfg. Lot Number:
Rocap Test Requirement(s): Na
Lubricant Requirements(s): No
