Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001383 DEA: 010P9004 EFIS: 0125000088
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-19.1/20.1
Work Description: REPAIR STORM DAMAGE. REPAIR ROADWAY EMBANKMENT WITH RETAINING WALL
Location Description: IN HUMBOLDT COUNTY NEAR BRIDGEVILLE FROM 1.1 TO 0.1 MILE WEST OF VAN DUZEN RIVER BRIDGE.
Contractor Name: JF Shea Construction
Contractor Address: Unknown
Resident Engineer: Joseph Lasensky Structure Rep.: Jordan St. John
DIME Sample ID: 2026-06-25-1
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: 06/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/07/2026
The quantity of what the sample constitutes: 86
A brief description of the sample: F1554 Hex Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales Inc
Rocap Number(s): na
Heat Number(s): 20147050
Nut Mfg. Lot Number(s): na
Washer Mfg. Lot Number(s): na
Bolt Specification: F1554 Gr 105
Bolt Length(s): 36"
Nut Specification: na
Washer Specification: na
Finish: HDG
Diameter/Size: 1-1/4"
Bolt Mfg. Lot Number: 4601
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
DIME Test ID: 2026-06-25-1-1
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: 2026-06-25-1-2
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.
