Sample Record
Owner Lab
- CT HQ - QASI Bay Area Field Office
DIME Sample ID 2018-04-25-1
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Project Information
| Project Identifiers | Project ID: 213087 Permit Numbers: 0916NCS0245 0917NDP0279 0917NRW0191 |
|---|---|
| DIST-CO-RTE-PM | 09-KER-14-16.3/17.1 |
| Award Date | 12/29/2016 |
| Closeout Date | 06/23/2021 |
| Work Description | Construct sidewalk, curb and gutter, as shown on the plans titled "Plans for Construction of Pedestrian Path Improvements on State Route 14 in Mojave, CA, Contract No. 16007" signed and stamped by Registered Civil Engineer Bryon A. Smith, RCE No. 61252.Notwithstanding General Provision #4, |
| Location Description | Mojave, Mojave |
| QA Service Level | 1 (Verified on 02/01/2018) |
Sample Information
| Sample Taken Date | 04/25/2018 | 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 | 04/26/2018 |
| Sample type | Verification | A brief description of the sample | 1 x 3-4 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 Fasteners | Transportation Laboratory (TL) Number | C719150 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | B76-078-18 | Structure unique identifier | Not set |
| Structure name | Not set |
Material Information
| Material Type | SMTL TM3 - Fastener Assembly | Rocap Number(s) | none |
|---|---|---|---|
| Heat Number(s) | M42681, DL17101378, 175125, DL12102282 | Nut Mfg. Lot Number(s) | Nucor 3257198, 393694A |
| Washer Mfg. Lot Number(s) | Technical 1017-672 | Bolt Specification | F1554 Gr.105 |
| Bolt Length(s) | 1" x 3'-4" | Nut Specification | A194 Gr.2H |
| Washer Specification | F436 | Finish | HDG/plain |
| Diameter/Size | 1" x 3'-4" | Bolt Mfg. Lot Number | Kreher 78641 |
| 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. | |||