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Sample Record for 2026-02-23-1

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

Project Information

Project ID: 1000611 DEA: 120R32U4 EFIS: 1222000054 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-55-0.2/R17.8
Work Description: COLD PLANE, PLACE RHMA, REPLACE CB, SIGNS AND MODIFY LIGHTING SYSTEM.
Location Description: ORANGE COUNTY FROM 0.1 MILE SOUTH OF ROUTE 55/1 SEPARATION IN NEWPORT BEACH TO ROUTE 55/91 SEPARATION IN ANAHEIM
Contractor Name: R.J. NOBLE COMPANY
Contractor Address: 15505 East Lincoln Avenue, Orange, CA 92865
Resident Engineer: Tyrone Taylor Structure Rep.: Matthew Chang

Sample Information

DIME Sample ID: 2026-02-23-1
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: Per Request
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 02/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/02/2026
The quantity of what the sample constitutes: 276
A brief description of the sample: 3" Anchor Bolt Assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo Structural Products

Material Information

Rocap Number(s): NA
Heat Number(s): 79018795, 73126616, 190155263
Nut Mfg. Lot Number(s): BVJB
Washer Mfg. Lot Number(s): 190155263
Bolt Specification: ASTM F1554 Gr 55 S-1
Bolt Length(s): 75.5
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 3"
Bolt Mfg. Lot Number: 7901879504
Rocap Test Requirement(s): NA
Lubricant Requirements(s): NA
Washer Inner Diameter(s): NA
Test results on following page(s): 6

Test Results

Test 1 of 6

DIME Test ID: 2026-02-23-1-1
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.

Test 2 of 6

DIME Test ID: 2026-02-23-1-2
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.

Test 3 of 6

DIME Test ID: 2026-02-23-1-3
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.

Test 4 of 6

DIME Test ID: 2026-02-23-1-4
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.

Test 5 of 6

DIME Test ID: 2026-02-23-1-5
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.

Test 6 of 6

DIME Test ID: 2026-02-23-1-6
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.