Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2020-05-18-6

Project Information

Project IdentifiersProject ID: 213746
DEA: 080Q75U4
EFIS: 0817000114
DIST-CO-RTE-PM08-SBD,RIV-60-R4.6/R9.9, R0.0/12.2
Award Date04/18/2019
Closeout Date06/28/2022
Location DescriptionNot set
QA Service Level1 (Verified on 06/17/2019)

Sample Information

Sample Taken Date05/18/2020 Sample Unique Key6
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 typeVerification A brief description of the sample1.5" x 52" DE anchor rod
The quantity of what the sample constitutes21 From where was the sample collectedManufacturer
First name of sampler or witnessed byKenneth Last name of sampler or witnessed byVarela
Title of samplerAssociate Steel Inspector Telephone number of sampler(562) 440-7716
Laboratory sample identificationUnknown Linked DIME Sample ID
The fabricator/manufacturer/facility nameEDSCO Fasteners Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) FormL08-049-20 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)N/A
Heat Number(s)3092321 Nut Mfg. Lot Number(s)DDYD / 27217-62144843
Washer Mfg. Lot Number(s)Wrought Bolt SpecificationF1554 Gr. 55
Bolt Length(s)52" Nut SpecificationA194 2H
Washer SpecificationF436 Finishpartial HDG
Diameter/Size1.5 Bolt Mfg. Lot NumberDyson HDG and Unytite
Rocap Test Requirement(s)None Lubricant Requirements(s)None

Submitted Tests

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