Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002104 DEA: 07369604 EFIS: 0719000376
QA Service Level: 1
DIST-CO-RTE-PM: 07-UNKNOWN--unknown
Work Description:
Location Description:
Contractor Name: Peterson Chase Construction
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Nzhde Matecosyan Structure Rep.: Adriana Pimienta
DIME Sample ID: 2026-06-04-7
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: 06/04/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/04/2026
The quantity of what the sample constitutes: 2500
A brief description of the sample: 1-1/8" Flat Washer
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales
Rocap Number(s): N/A
Heat Number(s): 132113
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): 36893-132113
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: N/A
Washer Specification: F436
Finish: Mechanical Galvanization
Diameter/Size: 1-1/8"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): 0
Lubricant Requirements(s): 0
Washer Inner Diameter(s): 0
DIME Test ID: 2026-06-04-7-1
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: 07/06/2026
Date Tested: 06/30/2026
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
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
|
36893-132113
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3.3 mils
|
DIME Test ID: 2026-06-04-7-2
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: 07/06/2026
Date Tested: 06/30/2026
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
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
|
36893-132113
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3.5 mils
|
DIME Test ID: 2026-06-04-7-3
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: 07/06/2026
Date Tested: 06/30/2026
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
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
|
Sample No.
|
1C
|
|
Rocap Number
|
no data
|
|
Heat Number(s)
|
no data
|
|
Mfg. Lot Number
|
36893-132113
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3.2 mils
|
DIME Test ID: 2026-06-04-7-4
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 07/06/2026
Date Tested: 06/30/2026
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
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
|
36893-132113
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Hardness Reading Scale
|
C Scale
|
|
Hardness Reading Average
|
39
|
|
Spacing
|
Ok
|
DIME Test ID: 2026-06-04-7-5
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 07/06/2026
Date Tested: 06/30/2026
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
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
|
36893-132113
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Hardness Reading Scale
|
C Scale
|
|
Hardness Reading Average
|
39
|
|
Spacing
|
Ok
|
DIME Test ID: 2026-06-04-7-6
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 07/06/2026
Date Tested: 06/30/2026
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
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
|
Sample No.
|
1C
|
|
Rocap Number
|
no data
|
|
Heat Number(s)
|
no data
|
|
Mfg. Lot Number
|
36893-132113
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Hardness Reading Scale
|
C Scale
|
|
Hardness Reading Average
|
40
|
|
Spacing
|
Ok
|
