Sample Record

Owner Lab

  • CT HQ - QASI Bay Area Field Laboratory

DIME Sample ID 2020-11-18-8

Project Information

Project IdentifiersProject ID: 214601
DEA: 041J5694
EFIS: 0419000313
DIST-CO-RTE-PM04-SM-101-0.0/21.8
Award Date12/03/2019
Closeout Date09/28/2022
Work DescriptionSan Mateo US 101 Express Lanes North
Location DescriptionNot set
QA Service Level1 (Verified on 04/08/2022)

Sample Information

Sample Taken Date11/18/2020 Sample Unique Key8
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 testing11/18/2020
Sample typeQuality Assurance A brief description of the sample A325 Bolt Assembly
The quantity of what the sample constitutes39 From where was the sample collectedFabricator
First name of sampler or witnessed byKen Last name of sampler or witnessed byRiley
Title of samplerQuality Assurance Inspector Telephone number of sampler510-520-4147
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameStructural and Steel Products Transportation Laboratory (TL) NumberTL-102
Inspector Lot Number from the Transportation Laboratory (TL) FormB389-012-20 Structure unique identifier
Structure nameOHSS S63

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)M4400R
Heat Number(s)NF15201353, 75070238, 273919 Nut Mfg. Lot Number(s)27724-75070238
Washer Mfg. Lot Number(s)D4382 Bolt SpecificationASTM A325
Bolt Length(s)4-1/4" Nut SpecificationA563
Washer SpecificationF436 FinishMech Galv-B695
Diameter/Size1-1/2"x4-1/4" Bolt Mfg. Lot Number21060-NF15201353
Rocap Test Requirement(s)Yes Lubricant Requirements(s)Yes

Submitted Tests

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