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Sample Record for 2025-09-25-12

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

Project Information

Project ID: 1000176 DEA: 034H76U4 EFIS: 0323000040 QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-32-5.0/10.2
Work Description: REHABILITATE PAVEMENT, INSTALL SIGNAL, LIGHTING, DRAINAGE, & ADA RAMPS
Location Description: BUTTE COUNTY IN CHICO FROM MUIR AVENUE TO INTERCHANGE OF STATE ROUTES 99 AND 32
Contractor Name: BALDWIN CONTRACTING COMPANY, INC. DBA KNIFE RIVER CONSTRUCTION
Contractor Address: 1764 SKYWAY, CHICO CA 95928
Resident Engineer: Husam Makhoul Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2025-09-25-12
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/25/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/29/2025
The quantity of what the sample constitutes: 104 Assy
A brief description of the sample: ASTM F1554 DR 55 Anchor Bolt Assy
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo Structural Products

Material Information

Rocap Number(s):
Heat Number(s): Rod 79018344 Nut 10878070 Washer 240421
Nut Mfg. Lot Number(s): E268O1
Washer Mfg. Lot Number(s): E6873
Bolt Specification: ASTM F1554 GR55
Bolt Length(s): 30"
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2025-09-25-12-1
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
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
Data has not been verified.

Test 2 of 2

DIME Test ID: 2025-09-25-12-2
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
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
Data has not been verified.