Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2022-03-18-3

Project Information

Project IdentifiersProject ID: 215371
DEA: 042W1204
EFIS: 0421000139
DIST-CO-RTE-PM04-CC,CC/MRN-580-6.9/7.8, 6.9, 7.8, 02, 5
Award Date01/11/2020
Closeout Date09/06/2022
Work DescriptionREPLACEMENT OF GUSSET PLATES AT VARIOUS LOCATIONS
Location DescriptionRichmond San Rafael Bridge
QA Service Level1 (Verified on 12/14/2020)

Sample Information

Sample Taken Date03/18/2022 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 sampleAll-Thread Rod
The quantity of what the sample constitutes24 From where was the sample collectedDistributor
First name of sampler or witnessed byBrian Last name of sampler or witnessed byMurray
Title of samplerQA Inspector Telephone number of sampler213 435 4055
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameLiberty Bolt Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL140-040-22 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)n/a
Heat Number(s)11722380 Nut Mfg. Lot Number(s)n/a
Washer Mfg. Lot Number(s)n/a Bolt SpecificationASTM A354-BD
Bolt Length(s)71" Nut Specificationn/a
Washer Specificationn/a FinishHot Dipped Galvanized
Diameter/Size1 1/8" Bolt Mfg. Lot Numbern/a
Rocap Test Requirement(s) Lubricant Requirements(s)

Submitted Tests

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