Sample Record

Owner Lab

  • CT HQ - QASI Bay Area Field Laboratory

DIME Sample ID 2017-06-28-1

Project Information

Project IdentifiersProject ID: 211371
DEA: 120H2434
EFIS: 1214000038
DIST-CO-RTE-PM12-LA,ORA-91-R20.6/R20.7,R0.0/R2.8
Award Date06/15/2016
Closeout Date08/27/2018
Work DescriptionINSTALL FIBER OPTIC CABLE & CCTVS
Location DescriptionORANGE 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 Level1 (Verified on 09/01/2016)

Sample Information

Sample Taken Date06/28/2017 Sample Unique Key1
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 testing06/28/2017
Sample typeVerification A brief description of the sample2 1/4 x 54 anchor bolt assembly
The quantity of what the sample constitutes1 From where was the sample collectedFabricator
First name of sampler or witnessed byDavid Last name of sampler or witnessed byFlygare
Title of samplerCA METS QA Inspector Telephone number of sampler801-669-2984
Laboratory sample identificationUnknown Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameEDSCO Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) FormB76-075-17 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeSMTL 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 SpecificationF1554 gr.55
Bolt Length(s)54 Nut SpecificationA194-2H
Washer SpecificationF436 FinishHDG/plain
Diameter/Size2 1/4 Bolt Mfg. Lot NumberHT- 3064247
Rocap Test Requirement(s)none Lubricant Requirements(s)

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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