Sample Record for 2016-12-01-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211004 DEA: 05330784 EFIS: 0512000076
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-46-46.0/50.2
Work Description: CONVERT 2-LANE TO 4 LANE EXPRESSWAY.
Location Description: NEAR SHANDON FROM 0.2 MILE EAST OF MCMILLIAN CANYON ROAD TO 0.4 MILE WEST OF LUCY BROWN ROAD
Contractor Name: BROSAMER & WALL, INC.
Contractor Address: 1777 Oakland Blvd., Suite 300, Walnut Creek, CA 94596
Resident Engineer: Amy Norris Structure Rep.: Nick Heisdorf
Sample Information
DIME Sample ID: 2016-12-01-1
TL Number from the TL Form:
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 TM3 - Fastener Assembly
Sample Taken Date: 12/01/2016
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 36
A brief description of the sample: A449 Bolt/nut/Washer
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Portland Bolt
Material Information
Rocap Number(s): N/A
Heat Number(s): Bolt- 3051123 Nut 75062745, washer 267181
Nut Mfg. Lot Number(s): 23468-75062745
Washer Mfg. Lot Number(s): 0616-264
Bolt Specification: ASTM A449
Bolt Length(s): 15.5"
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: ASTM A153 - Hot Dip
Diameter/Size: 7/8"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test Results
