Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002212 DEA: 033J3104 EFIS: 0322000248
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-12-3.5/3.8
Work Description: Jackson Slough Road Intersection Improvement
Location Description:
Contractor Name: TIM PAXINS PACIFIC EXCAVATION, INC
Contractor Address: 9796 Kent Street, Elk Grove CA 95624
Resident Engineer: Lorraine Tullo Structure Rep.: Nicolas Sanders
DIME Sample ID: 2026-06-12-4
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: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 06/12/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/10/2026
The quantity of what the sample constitutes: 3 of 442
A brief description of the sample: F1554 Grade 55 HDG Anchor Bolts
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corp
Rocap Number(s): N/A
Heat Number(s): 1201071738
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): N/A
Bolt Specification: F1554
Bolt Length(s): 42"
Nut Specification: N/A
Washer Specification: N/A
Finish: Galvanized
Diameter/Size: 2-1/4
Bolt Mfg. Lot Number: 120107173822
Rocap Test Requirement(s): none
Lubricant Requirements(s): none
Washer Inner Diameter(s): none
DIME Test ID: 2026-06-12-4-1
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: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
DIME Test ID: 2026-06-12-4-2
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.
DIME Test ID: 2026-06-12-4-3
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.
