Sample Record for 2025-11-23-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001375 DEA: 040A53T4 EFIS: 0421000155 COOP: 040A53TCM
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80-L1.8/L3.2
Work Description: Construct I-80 WB Truck Scales
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SOLANO COUNTY IN AND NEAR FAIRFIELD ON ROUTE 12 FROM THE 80/12 EAST JUNCTION TO 0.9 MILE EAST OF CHADBOURNE ROAD UNDERCROSSING AND ON ROUTE 80 FROM 0.5 MILE WEST OF DAN WILSON CREEK BRIDGE TO WEST TEXAS STREET UNDERCROSSI
Contractor Name: Kiewit Infrastructure West Co.
Contractor Address: 4650 Business Center Drive, Fairfield, CA 94534
Resident Engineer: Darren Isada Structure Rep.: Nana Budu
Sample Information
DIME Sample ID: 2025-11-23-4
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: 11/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/02/2025
The quantity of what the sample constitutes: 2
A brief description of the sample: 1" x 16-1/2"
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Portland Bolt - Oregon
Material Information
Rocap Number(s):
Heat Number(s): Bolt 3140707
Nut 8000037453
Washer 241928
Nut Mfg. Lot Number(s): W000279453
Washer Mfg. Lot Number(s): 0225-558
Bolt Specification: 1" x 16-1/2" dom. galv. F1554-36 hex head bolt with 5" thd.
Bolt Length(s): 16-1/2"
Nut Specification: 1" dom. galv. A563-DH heavy hex nut
Washer Specification: 1" dom. galv. F436-1 hard washer
Finish: HDG
Diameter/Size: 1"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test Results
Test 1 of 1
DIME Test ID: 2025-11-23-4-1
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.
