Sample Record

Owner Lab

  • CT HQ - Sacramento Materials Management Branch Field Office

DIME Sample ID 2021-02-01-8

Project Information

Project IdentifiersProject ID: 214601
DEA: 041J5694
EFIS: 0419000313
DIST-CO-RTE-PM04-SM-101-0.0/21.8
Award DateNot set
Closeout DateNot set
Work DescriptionBarrier modifications, overhead signs, freeway lighting and electronic toll system components
Location DescriptionSANTA CLARA AND SAN MATEO COUNTIES FROM 0.3 MILE NORTH OF SAN ANTONIO ROAD TO 0.3 MILE SOUTH OF GRAND AVENUE INTERCHANGE
QA Service Level1 (Verified on 02/21/2020)

Sample Information

Sample Taken Date02/01/2021 Sample Unique Key8
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 sample3 sets, each set is one 2.25" rod, 1 2.25" galvanized nut, 1 2.25" black nut and 2.25" washer
The quantity of what the sample constitutes3 sets . sampled remotely From where was the sample collectedOther
First name of sampler or witnessed byFrederic Last name of sampler or witnessed byAboujaoude
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameMadden Bolts Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL147-001-21 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)
Heat Number(s)58043509 Nut Mfg. Lot Number(s)DECC
Washer Mfg. Lot Number(s)M040606 Bolt Specification F1554, Grade 55
Bolt Length(s) Nut SpecificationASTM 563 and ASTM A194, Grade 2H
Washer Specification flat washer, ASTM 436 FinishHDG
Diameter/Size2.25" 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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