Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000320 DEA: 11430324 EFIS: 1118000102
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-805-14.6/23.7
Work Description: MODIFY ELECTRICAL, CONCRETE PAVEMENT, DRAINAGE AND SIGNS.
Location Description: SAN DIEGO COUNTY IN SAN DIEGO FROM ROUTE 805/15 SEPARATION TO 0.1 MILE NORTH OF ROUTE 805/52 SEPARATION
Contractor Name: COFFMAN SPECIALTIES, INC.
Contractor Address: 9685 VIA EXCELENCIA STE 200, SAN DIEGO, CA 92126
Resident Engineer: Art Pannu Structure Rep.: Jose Delgado
DIME Sample ID: 2026-06-25-14
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: 06/25/2026
The quantity of what the sample constitutes: 3500
A brief description of the sample: A563-DH
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): 10893760
Nut Mfg. Lot Number(s): 24-23-010
Washer Mfg. Lot Number(s): na
Bolt Specification: na
Bolt Length(s): na
Nut Specification: A563-DH
Washer Specification: na
Finish: MG
Diameter/Size: 1/2"
Bolt Mfg. Lot Number: na
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
DIME Test ID: 2026-06-25-14-1
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: 07/22/2026
Date Tested: 07/22/2026
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.
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1A
|
|
Rocap Number
|
no data
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|
Heat Number(s)
|
no data
|
|
Mfg. Lot Number
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24-23-010
|
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Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
0.5 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3.1 mils
|
DIME Test ID: 2026-06-25-14-2
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: 07/22/2026
Date Tested: 07/22/2026
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.
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1B
|
|
Rocap Number
|
no data
|
|
Heat Number(s)
|
no data
|
|
Mfg. Lot Number
|
24-23-010
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
0.5 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
2.6 mils
|
DIME Test ID: 2026-06-25-14-3
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: 07/22/2026
Date Tested: 07/22/2026
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
|
24-23-010
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
0.5 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3 mils
|
DIME Test ID: 2026-06-25-14-4
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: 07/22/2026
Date Tested: 07/22/2026
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.
|
1D
|
|
Rocap Number
|
no data
|
|
Heat Number(s)
|
no data
|
|
Mfg. Lot Number
|
24-23-010
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
no data
|
|
Size
|
0.5 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3.2 mils
|
DIME Test ID: 2026-06-25-14-5
Test Method: ASTM F606-21: Standard Test Methods for Determining the Mechanical Properties of Externally and Internally Threaded Fasteners, Washers, Direct Tension Indicators, and Rivets (Proof Load with Wedge)
Verified Date: 07/22/2026
Date Tested: 07/22/2026
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:
|
Number of Bolt Samples
|
3
|
| Sample | Bolt Mfg. Lot Number | Size (in) | Peak Load (lbf) | Peak Load (kN) | Wedge Angle (deg) | Comments | Tested By | | 1A | 24-23-010 | 0.5 | 24833 | 0 | 0 | Nut Proof Load | Kleinfelder | | 1B | 24-23-010 | 0.5 | 24833 | 0 | 0 | Nut Proof Load | Kleinfelder | | 1C | 24-23-010 | 0.5 | 24833 | 0 | 0 | Nut Proof Load | Kleinfelder |
| |
|
UTM
|
NA
|
|
Temperature
|
0 f
|
