Sample Record for 2023-09-12-11
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215479 DEA: 080R4204 EFIS: 0812000076
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-SR 210 AND I-15 IC-Null
Work Description: FONTANA MAINTENANCE STATION
Location Description: 14032 Victoria Street, Fontana, CA 92336
Contractor Name: Stronghold Engineering, Inc.
Contractor Address: 150 W. Walnut Ave, Perris, CA 92571
Resident Engineer: Tim Flores Structure Rep.: Alfredo Flores
Sample Information
DIME Sample ID: 2023-09-12-11
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: 09/12/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/15/2023
The quantity of what the sample constitutes: 80
A brief description of the sample: 7/8 x 15 5/8" Anchor Bolts A36
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Maya Steel Fabrications, Inc
Material Information
Rocap Number(s): N/A
Heat Number(s): 223747, 190934
Nut Mfg. Lot Number(s): 33301-190934
Washer Mfg. Lot Number(s): S1603001
Bolt Specification: ASTM F1554 Grade 36
Bolt Length(s): 15 5/8"
Nut Specification: ASTM A563, Grade DH
Washer Specification: ASTM F436
Finish: Black
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: ALTON STEEL INC
223747
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test Results
