Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2023-09-12-10

Project Information

Project IdentifiersProject ID: 215479
DEA: 080R4204
EFIS: 0812000076
Award Date05/03/2021
Closeout DateNot set
Location Description14032 Victoria Street, Fontana, CA 92336
QA Service Level1 (Verified on 02/11/2021)

Sample Information

Sample Taken Date09/12/2023 Sample Unique Key10
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 testing09/15/2023
Sample typeQuality Assurance A brief description of the sample3/4 x 11" Anchor Bolts A36
The quantity of what the sample constitutes28 From where was the sample collectedFabricator
First name of sampler or witnessed byHuidon Last name of sampler or witnessed byJoo
Title of samplerQuality Assurance Inspector Telephone number of sampler562-447-5379
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameMaya Steel Fabrications, Inc Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL163-067-23 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM3 - Fastener Assembly Rocap Number(s)N/A
Heat Number(s)3118926, 5804880203, 32030360 Nut Mfg. Lot Number(s)35918-5804880203
Washer Mfg. Lot Number(s)164336 Bolt SpecificationASTM F1554 Grade 36
Bolt Length(s)11" Nut SpecificationASTM A563 HHN, Grade DH
Washer SpecificationASTM F436 FinishBlack
Diameter/Size3/4" Bolt Mfg. Lot NumberCMC STEEL TEXAS 3118926
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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Test File Attachments