Sample Record
Owner Lab
- CT HQ - QASI Bay Area Field Office
DIME Sample ID 2019-04-17-4
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 213788 DEA: 120Q5204 EFIS: 1217000057 MINOR: 12A1741 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-12,133-8.29 |
| Award Date | Not set |
| Closeout Date | 07/02/2024 |
| Work Description | Remove seven electroliers, install high-mast lighting ,asphalt and optical speed bar and Install safety lighting & optical speed bar |
| Location Description | Route 133 |
| QA Service Level | 1 (Verified on 01/16/2019) |
Sample Information
| Sample Taken Date | 04/17/2019 | Sample Unique Key | 4 |
|---|---|---|---|
| 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 | 04/19/2019 |
| Sample type | Verification | A brief description of the sample | 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 | CT METS QA INSPECTOR | Telephone number of sampler | 8016692984 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | EDSCO Fasteners | Transportation Laboratory (TL) Number | C720609 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | B76-051-19 | Structure unique identifier | Not set |
| Structure name | Not set |
Material Information
| Material Type | SMTL TM3 - Fastener Assembly | Rocap Number(s) | none |
|---|---|---|---|
| Heat Number(s) | 3084898, 188194, 176419, 177682 | Nut Mfg. Lot Number(s) | Dyson - DDYO, DDYC |
| Washer Mfg. Lot Number(s) | Wrought 308878 | Bolt Specification | F1554 Gr. 55 |
| Bolt Length(s) | 4'-5" | Nut Specification | A194 2H |
| Washer Specification | F436 HDG | Finish | HDG and plain |
| Diameter/Size | 2" x 4'-5" | Bolt Mfg. Lot Number | EDSCO no lot number |
| Rocap Test Requirement(s) | none | Lubricant Requirements(s) | yes |
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. | |||