Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2019-06-13-9

Project Information

Project IdentifiersProject ID: 209139
DEA: 071170U4
EFIS: 0700000085
DIST-CO-RTE-PM07-LA-10-33.2/37.2
Award Date02/10/2014
Closeout Date03/01/2022
Work DescriptionCONSTRUCT HOV LANES, WIDEN BRIDGES, AND REALIGN RAMPS.
Location DescriptionLOS ANGELES COUNTY IN BALDWIN PARK AND WEST COVINA FROM 0.1 MILE WEST OF PUENTE AVENUE UNDERCROSSING TO 0.2 MILE EAST OF HOLLENBECK STREET UNDERCROSSING
QA Service Level1 (Verified on 05/06/2014)

Sample Information

Sample Taken Date06/13/2019 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 testing06/20/2019
Sample typeQuality Assurance A brief description of the sampleASTM F1554 Gr 55 Anchor Bolt
The quantity of what the sample constitutes5 From where was the sample collectedManufacturer
First name of sampler or witnessed byChristopher Last name of sampler or witnessed byDsouza
Title of sampler Telephone number of sampler6469423585
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameBlue Circle Corp Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)
Heat Number(s) Nut Mfg. Lot Number(s)
Washer Mfg. Lot Number(s) Bolt SpecificationN/A
Bolt Length(s)Unknown Nut SpecificationN/A
Washer SpecificationN/A 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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