Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993911 DEA: 071XY804 EFIS: 0722000229
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA/LA-47-RO 42/1.98
Work Description: Fabricate and paint metal cable guards and install them onto the main cables of the Vincent Thomas Bridge
Location Description:
Contractor Name: Griffith Company
Contractor Address: 3050 E. Birch Street, Brea, CA 92821
Resident Engineer: Thang Ton Structure Rep.: Andy Chen
DIME Sample ID: 2023-07-24-1
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: 07/24/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 26
A brief description of the sample: HS Fastener Assembly
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Wecall Engineering
Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s): DEFN
Washer Mfg. Lot Number(s): 1022-525
Bolt Specification: ASTM A354 Grade B/C
Bolt Length(s): 13"
Nut Specification: ASTM A563 HD
Washer Specification: ASTM F436 Type 1
Finish: HDG
Diameter/Size: 1-1/2”
Bolt Mfg. Lot Number: 20784
Rocap Test Requirement(s):
Lubricant Requirements(s):
