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Sample Record for 2025-02-19-3

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 1000315 DEA: 07301604 EFIS: 0714000024 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91,110,710-Var
Work Description: INSTALL FIBER REINFORCED POLYMER SYSTEM (COLUMN) AND COLUMN CASING.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: POWELL CONSTRUCTORS, INC. - Andrew Sanchez
Contractor Address: 8555 BANANA AVENUE, FONTANA CA 92335
Resident Engineer: Ramon Robillos Structure Rep.: Anayo Ukwuani

Sample Information

DIME Sample ID: 2025-02-19-3
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 02/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 03/12/2025
The quantity of what the sample constitutes: 118
A brief description of the sample: F436 FW
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales, Inc.

Material Information

Rocap Number(s): na
Heat Number(s): 212086
Nut Mfg. Lot Number(s): na
Washer Mfg. Lot Number(s): na
Bolt Specification: na
Bolt Length(s): na
Nut Specification: na
Washer Specification: F436
Finish: MG
Diameter/Size: 1-1/2"
Bolt Mfg. Lot Number: 253046
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s):
Test results on following page(s): 4

Test Results

Test 1 of 4

DIME Test ID: 2025-02-19-3-1
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: 04/21/2025
Date Tested: 04/21/2025
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:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 253046
Finish Coating ASTM B695 - Mech Galv
Product Markings no data
Size 1.5 in
Bolt Length no data in
Measurement Average 3.4 mils

Test 2 of 4

DIME Test ID: 2025-02-19-3-2
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: 04/21/2025
Date Tested: 04/21/2025
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:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 253046
Finish Coating ASTM B695 - Mech Galv
Product Markings no data
Size 1.5 in
Bolt Length no data in
Measurement Average 2.9 mils

Test 3 of 4

DIME Test ID: 2025-02-19-3-3
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 04/21/2025
Date Tested: 04/21/2025
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:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 253046
Finish Coating ASTM B695 - Mech Galv
Product Markings no data
Size 1.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 36.3
Spacing Ok

Test 4 of 4

DIME Test ID: 2025-02-19-3-4
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 04/21/2025
Date Tested: 04/21/2025
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:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 253046
Finish Coating ASTM B695 - Mech Galv
Product Markings no data
Size 1.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 36.8
Spacing Ok