Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994673 DEA: 033F0704 EFIS: 0312000054
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-2.0/3.5
Work Description: American River Bridge Rehabilitation
Location Description:
Contractor Name: American River Constructors
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: John Ruzic Structure Rep.: Pha Tran
DIME Sample ID: 2026-02-19-1
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: 02/19/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/26/2026
The quantity of what the sample constitutes: 142
A brief description of the sample: 3/4"x 9"
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Bolt, San Leandro, CA
Rocap Number(s):
Heat Number(s): Bolt 10963010
Nut 1000129174
Washer 249480
Bevel Washer 100230143
Nut Mfg. Lot Number(s): W000241461
Washer Mfg. Lot Number(s): Washer 249480 and Beveled Washer E7697
Bolt Specification: 3/4" x 9-1/2" ASTM F1554-105
Bolt Length(s): 9-1/2"
Nut Specification: 3/4" ASTM A194 GR-2H
Washer Specification: 3/4 ASTM F436 Washer and Bevel Washer
Finish: HDG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: .750
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
DIME Test ID: 2026-02-19-1-1
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: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
DIME Test ID: 2026-02-19-1-2
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: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
