Sample Record
Owner Lab
- CT HQ - QASI Bay Area Field Office
DIME Sample ID 2017-06-28-1
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 211371 DEA: 120H2434 EFIS: 1214000038 |
|---|---|
| DIST-CO-RTE-PM | 12-LA,ORA-91-R20.6/R20.7,R0.0/R2.8 |
| Award Date | 06/15/2016 |
| Closeout Date | 08/27/2018 |
| Work Description | INSTALL FIBER OPTIC CABLE & CCTVS |
| Location Description | ORANGE AND LOS ANGELES COUNTIES IN LA PALMA, BUENA PARK AND CERRITOS FROM 0.1 MILE WEST OF LOS ANGELES COUNTY LINE TO STANTON AVENUE UNDERCROSSING |
| QA Service Level | 1 (Verified on 09/01/2016) |
Sample Information
| Sample Taken Date | 06/28/2017 | Sample Unique Key | 1 |
|---|---|---|---|
| Will the laboratory/organization for which you are a member perform testing on this material sample? | Yes | Date that the sample was received by the laboratory/organization performing the testing | 06/28/2017 |
| Sample type | Verification | A brief description of the sample | 2 1/4 x 54 anchor bolt assembly |
| The quantity of what the sample constitutes | 1 | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | David | Last name of sampler or witnessed by | Flygare |
| Title of sampler | CA METS QA Inspector | Telephone number of sampler | 801-669-2984 |
| Laboratory sample identification | Unknown | Linked DIME Sample ID | Unknown |
| The fabricator/manufacturer/facility name | EDSCO | Transportation Laboratory (TL) Number | Unknown |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | B76-075-17 | Structure unique identifier | Not set |
| Structure name | Not set |
Material Information
| Material Type | SMTL TM3 - Fastener Assembly | Rocap Number(s) | none |
|---|---|---|---|
| Heat Number(s) | A163193, 235222, 190821, 3064247 | Nut Mfg. Lot Number(s) | ameribolt W1741, Dyson DCRO |
| Washer Mfg. Lot Number(s) | HT 235222 | Bolt Specification | F1554 gr.55 |
| Bolt Length(s) | 54 | Nut Specification | A194-2H |
| Washer Specification | F436 | Finish | HDG/plain |
| Diameter/Size | 2 1/4 | Bolt Mfg. Lot Number | HT- 3064247 |
| Rocap Test Requirement(s) | none | Lubricant Requirements(s) |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||