Sample Record
Owner Lab
- CT QASI - Sacramento Field Laboratory
DIME Sample ID 2021-03-05-5
Project Information
| Project Identifiers | Project ID: 215032 DEA: 030H5204 EFIS: 0315000202 |
|---|---|
| DIST-CO-RTE-PM | 03-ED-50-0.0/80.4 |
| Award Date | 08/13/2020 |
| Closeout Date | Not set |
| Work Description | INSTALL CMS, CAMERA SYSTEMS AND TMS ELEMENTS. |
| Location Description | EL DORADO COUNTY AT VARIOUS LOCATIONS FROM THE SACRAMENTO COUNTY LINE TO CALIFORNIA/NEVADA STATE LINE |
| QA Service Level | 1 (Verified on 07/20/2020) |
Sample Information
| Sample Taken Date | 03/05/2021 | Sample Unique Key | 5 |
|---|---|---|---|
| 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 testing | 03/15/2021 |
| Sample type | Quality Assurance | A brief description of the sample | Anchor bolt 2.25" x 55" F1554-55 HDG |
| The quantity of what the sample constitutes | 171 anchor bolt assemblies | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Mark | Last name of sampler or witnessed by | Lara |
| Title of sampler | CT METS QA INSPECTOR | Telephone number of sampler | 610-662-4557 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Madden Bolt | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | B391-001-21 | Structure unique identifier | |
| Structure name |
Material Information
| Material Type | SMTL TM3 - Fastener Assembly | Rocap Number(s) | |
|---|---|---|---|
| Heat Number(s) | 58043509 06 | Nut Mfg. Lot Number(s) | DECC / 201206 |
| Washer Mfg. Lot Number(s) | 109259 | Bolt Specification | ASTM F1554 |
| Bolt Length(s) | 55" | Nut Specification | ASTM A194 |
| Washer Specification | F436 | Finish | HDG |
| Diameter/Size | 2.25" | Bolt Mfg. Lot Number | 58043509/06 |
| Rocap Test Requirement(s) | Lubricant Requirements(s) |