Sample Record for 2026-06-18-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1002103 DEA: 081T8404 EFIS: 0826000112
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-162.73
Work Description: SBD-15 Cima Rd Overcrossing (OC) Bridge Hit. Repair damaged bridge
Location Description:
Contractor Name: Beador Const. Co. Inc.
Contractor Address: 26320 LESTER CIRCLE, CORONA CA 92883
Resident Engineer: Khoa Nguyen Structure Rep.: Jegbefume Adodo
Sample Information
DIME Sample ID: 2026-06-18-6
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: 06/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/23/2026
The quantity of what the sample constitutes: 63 assemblies
A brief description of the sample: 7/8" x 2-3/4" assembly
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name: N/A
The fabricator/manufacturer/facility name: Cordova Bolt Inc.
Material Information
Rocap Number(s): CB-055-01 Rotational Capacity - W000160444-A
Heat Number(s): W000160444, W000272441, 0425-613
Nut Mfg. Lot Number(s): W000272441, 8000035507
Washer Mfg. Lot Number(s): 0425-613, 244311
Bolt Specification: ASTM A352
Bolt Length(s): 2 3/4"
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: Black
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: W000160444, 1000125298
Rocap Test Requirement(s): ASTM F3125 Caltrans Section 55
Lubricant Requirements(s): none
Washer Inner Diameter(s): none
Test Results
Test
DIME Test ID: 2026-06-18-6-1
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
DIME Test ID: 2026-06-18-6-2
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.
