Sample Record

Owner Lab

  • CT QASI - Sacramento Field Laboratory

DIME Sample ID 2019-10-31-2

Project Information

Project IdentifiersProject ID: 214141
DEA: 081J1204
EFIS: 0817000208
DIST-CO-RTE-PM08-RIV-15,91,215-Var
Award Date06/13/2019
Closeout Date02/07/2020
Work DescriptionREMOVE, PREPARE AND FURNISH POLYESTER CONCRETE OVERLAY.
Location DescriptionRIVERSIDE COUNTY AT VARIOUS LOCATIONS
QA Service Level1 (Verified on 08/23/2019)

Sample Information

Sample Taken Date10/31/2019 Sample Unique Key2
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testingNot set
Sample typeQuality Assurance A brief description of the sampleA325 HDG Rocap Assembiy
The quantity of what the sample constitutes24 From where was the sample collectedFabricator
First name of sampler or witnessed byMahlon Last name of sampler or witnessed byLindenmuth
Title of samplerQA Inspector Telephone number of sampler646-740-3704
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameCK Johnson Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormS46-922-19 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)424370B
Heat Number(s)100896901 Nut Mfg. Lot Number(s)406871A
Washer Mfg. Lot Number(s)C6542D Bolt SpecificationA325
Bolt Length(s)2-1/4" Nut SpecificationA563 Grade DH
Washer SpecificationF436 FinishHDG
Diameter/Size3/4" Bolt Mfg. Lot Number424370B
Rocap Test Requirement(s) Lubricant Requirements(s)Lubed

Submitted Tests

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