Sample Record

Owner Lab

  • CT HQ - QASI Sacramento Field Office

DIME Sample ID 2018-09-17-9

Project Information

Project IdentifiersProject ID: 212726
DEA: 030F3514
EFIS: 0316000080
DIST-CO-RTE-PM03-SAC-51,99-VAR
Award Date02/08/2018
Closeout Date12/08/2021
Work DescriptionROADWAY EXCAVATION, HOT MIX ASPHALT AND MODIFY ELECTRICAL SYSTEM; SOLDIER PILES; CONCRETE RETAINING WALL
Location DescriptionSACRAMENTO COUNTY FROM 0.5 MILE SOUTH OF COSUMNES RIVER BOULEVARD TO 0.2 MILE EAST OF ARDEN WAY UNDERCROSSING
QA Service Level1 (Verified on 04/02/2018)

Sample Information

Sample Taken Date09/17/2018 Sample Unique Key9
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 testing09/19/2018
Sample typeQuality Assurance A brief description of the sampleF1554 Anchor Rods Nut Washers
The quantity of what the sample constitutes17 From where was the sample collectedSource
First name of sampler or witnessed byJoe Last name of sampler or witnessed byAdame
Title of samplerQA Telephone number of sampler360-953-1155
Laboratory sample identificationUnknown Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility namePortland Bolt Transportation Laboratory (TL) NumberC874456
Inspector Lot Number from the Transportation Laboratory (TL) FormS43-043-18 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)
Heat Number(s)PL16207513 Nut Mfg. Lot Number(s)28769-622114705402
Washer Mfg. Lot Number(s)350118208020 Bolt SpecificationF1554
Bolt Length(s)10'' Nut SpecificationA563
Washer SpecificationA36/A529 FinishHDG
Diameter/Size3/4'' Bolt Mfg. Lot NumberPL162075135
Rocap Test Requirement(s) Lubricant Requirements(s)

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments