Sample Record

Owner Lab

  • CT QASI - Los Angeles Field Laboratory

DIME Sample ID 2017-09-19-1

Project Information

Project IdentifiersProject ID: 211796
DEA: 073X8704
EFIS: 0713000241
DIST-CO-RTE-PM07-LA-105,405-R2.5,20.5/R21.1
Award Date12/29/2016
Closeout Date04/08/2020
Work DescriptionSLOPE RECONSTRUCTION AND PAVEMENT REPAIR
Location DescriptionLOS ANGELES COUNTY IN AND NEAR HAWTHORNE FROM EL SEGUNDO BOULEVARD UNDERCROSSING TO ROUTE 105/405 SEPARATION
QA Service Level1 (Verified on 03/14/2017)

Sample Information

Sample Taken Date09/19/2017 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 testing09/22/2017
Sample typeQuality Assurance A brief description of the sampleA325 Fastener Assembly
The quantity of what the sample constitutes50 From where was the sample collectedFabricator
First name of sampler or witnessed byPrakash Last name of sampler or witnessed byPatel
Title of samplerTET II Telephone number of sampler(562) 665-4686
Laboratory sample identificationUnknown Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameStructural and Steel Products Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) FormL11-051-17 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)
Heat Number(s) Nut Mfg. Lot Number(s)
Washer Mfg. Lot Number(s) Bolt SpecificationF1554
Bolt Length(s)Unknown Nut SpecificationDH
Washer SpecificationHarden Finish
Diameter/SizeUnknown Bolt Mfg. Lot Number
Rocap Test Requirement(s) Lubricant Requirements(s)

Submitted Tests

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