Sample Record

Owner Lab

  • CT QASI - Sacramento Field Laboratory

DIME Sample ID 2021-02-02-3

Project Information

Project IdentifiersProject ID: 215032
DEA: 030H5204
EFIS: 0315000202
DIST-CO-RTE-PM03-ED-50-0.0/80.4
Award Date08/13/2020
Closeout DateNot set
Work DescriptionINSTALL CMS, CAMERA SYSTEMS AND TMS ELEMENTS.
Location DescriptionEL DORADO COUNTY AT VARIOUS LOCATIONS FROM THE SACRAMENTO COUNTY LINE TO CALIFORNIA/NEVADA STATE LINE
QA Service Level1 (Verified on 07/20/2020)

Sample Information

Sample Taken Date02/02/2021 Sample Unique Key3
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 sampleF1554 gr 55 2-1/4" x 70" Anchor bolt assembly
The quantity of what the sample constitutes168 assemblies From where was the sample collectedFabricator
First name of sampler or witnessed byJane Last name of sampler or witnessed byLillard
Title of samplerCALTRANS METS QA INSPECTOR Telephone number of sampler916-291-8042
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameMadden Bolt Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormS52-002-21 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 SpecificationASTM F1554 GR55
Bolt Length(s)70" Nut SpecificationN/A
Washer SpecificationN/A Finish
Diameter/Size 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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