Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2023-09-12-11
Project Information
Project Identifiers | Project ID: 215479 DEA: 080R4204 EFIS: 0812000076 |
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DIST-CO-RTE-PM | 08-SBD-SR 210 AND I-15 IC-Null |
Award Date | 05/03/2021 |
Closeout Date | Not set |
Work Description | FONTANA MAINTENANCE STATION |
Location Description | 14032 Victoria Street, Fontana, CA 92336 |
QA Service Level | 1 (Verified on 02/11/2021) |
Sample Information
Sample Taken Date | 09/12/2023 | Sample Unique Key | 11 |
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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 testing | 09/15/2023 |
Sample type | Quality Assurance | A brief description of the sample | 7/8 x 15 5/8" Anchor Bolts A36 |
The quantity of what the sample constitutes | 80 | From where was the sample collected | Fabricator |
First name of sampler or witnessed by | Huidon | Last name of sampler or witnessed by | Joo |
Title of sampler | Quality Assurance Inspector | Telephone number of sampler | 562-447-5379 |
Laboratory sample identification | Linked DIME Sample ID | ||
The fabricator/manufacturer/facility name | Maya Steel Fabrications, Inc | Transportation Laboratory (TL) Number | |
Inspector Lot Number from the Transportation Laboratory (TL) Form | L163-067-23 | Structure unique identifier | |
Structure name |
Material Information
Material Type | SMTL TM3 - Fastener Assembly | Rocap Number(s) | N/A |
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Heat Number(s) | 223747, 190934 | Nut Mfg. Lot Number(s) | 33301-190934 |
Washer Mfg. Lot Number(s) | S1603001 | Bolt Specification | ASTM F1554 Grade 36 |
Bolt Length(s) | 15 5/8" | Nut Specification | ASTM A563, Grade DH |
Washer Specification | ASTM F436 | Finish | Black |
Diameter/Size | 7/8" | Bolt Mfg. Lot Number | ALTON STEEL INC 223747 |
Rocap Test Requirement(s) | Lubricant Requirements(s) |
Submitted Tests
DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
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No results found. |
Sample File Attachments
File Name | Extension | Date Uploaded | Actions |
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No results found. |