Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214590 DEA: 043G4744 EFIS: 0412000074
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN,MRN-580-6.9/7.8,0.0/2.5
Work Description: CLEAN AND PAINT STRUCTURAL STEEL BRIDGE.
Location Description: CONTRA COSTA AND MARIN COUNTIES IN RICHMOND AND SAN RAFAEL FROM 0.8 MILE WEST OF TOLL PLAZA TO 0.1 MILE EAST OF MAIN STREET
Contractor Name: Allied Painting, INC.
Contractor Address: 4 Larwin Road, Cherry Hill, NJ08034
Resident Engineer: Behzad Halali Structure Rep.: William Sommer
DIME Sample ID: 2023-09-23-17
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: Per Request
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/23/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2023
The quantity of what the sample constitutes: 4
A brief description of the sample: A325 bolts
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 35-0038
Structure name: Dumbarton Bridge
The fabricator/manufacturer/facility name: Unknown
Rocap Number(s): Unknown
Heat Number(s): Unknown
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): N/A
Bolt Specification: ASTM A325
Bolt Length(s): Varies
Nut Specification: N/A
Washer Specification: N/A
Finish: Galvanized
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: Unknown
Rocap Test Requirement(s): Unknown
Lubricant Requirements(s): Unknown
