Project Information

Project ID: 1000580 DEA: 071XW104 EFIS: 0723000028 QA Service Level: 1

DIST-CO-RTE-PM: 07---

Work Description: VENTURA COUNTY IN CITY OF FILLMORE VEN-126REPLACE/CONSTRUCT THE FILLMORE MAINTENANCESTATION DAMAGED BY HIGH WINDS DIR\\'S EMERGENCY

Location Description:

Contractor Name: MGP CONSTRUCTION DBA MICHAEL

Contractor Address: PO BOX 355, UPLAND, CA 91785

Resident Engineer: ALFRED IRA Structure Rep.: Heidi Bernstein

Sample Information

DIME Sample ID: 2024-11-13-1

TL Number from the TL Form:

Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office

Sample Organization Contact: (858) 285-5797

Type of Sample: Quality Assurance

Type of Material: SMTL TM3 - Fastener Assembly

Sample Taken Date: 11/13/2024

Date that the sample was received by the laboratory/organization performing the testing: 12/03/2024

The quantity of what the sample constitutes: 38 Anchor Bolts

A brief description of the sample: 1"-8 x 54" ASTM F1554-GR 55

From where was the sample collected: Manufacturer

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Blue Circle Corporation

Material Information

Rocap Number(s):

Heat Number(s): 3133007

Nut Mfg. Lot Number(s):

Washer Mfg. Lot Number(s):

Bolt Specification: ASTM F1554 Grade 55

Bolt Length(s): 54"

Nut Specification: N/A

Washer Specification: N/A

Finish: ASTM F2329- Hot Dip Galvanized

Diameter/Size: 1"

Bolt Mfg. Lot Number: 98255

Rocap Test Requirement(s):

Lubricant Requirements(s):

Washer Inner Diameter(s):

Test Results

Test 1 of 2

DIME Test ID: 2024-11-13-1-1

Test Method: ASTM B499-09r21: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)

Verified Date: 12/12/2024

Date Tested: 12/11/2024

Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory

Organization Address: 5900 Folsom Boulevard,

Organization City: Sacramento

Organization State: CA

Organization Zipcode: 95819

Organization Email: joshua.moore@dot.ca.gov

Organization Phone: (530) 329-6527

General Comments for this Test: Atlas

Test Result Compliance:

Additional Comments When Verified:

Sample No.	1A
Rocap Number	no data
Heat Number(s)	3133007
Mfg. Lot Number	no data
Finish Coating	ASTM F2329 - Hot Dip
Product Markings	no data
Size	1.0 in
Bolt Length	54 in
Measurement Average	6.8 mils

Test 2 of 2

DIME Test ID: 2024-11-13-1-2

Test Method: ASTM A370-20: Standard Test Methods and Definitions for Mechanical Testing of Steel Products (Tensile - Round Sample)