Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994675 DEA: 07390204 EFIS: 0722000334
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-47-0.4 / 2.1
Work Description: Bridge deck replacement with lightweight precast deck panels ultra high performance concrete. Also includes: replacement of seismic sensors, upgrades to median barrier, railings, fences and guard rails. New finger joints.
Location Description: RTE 47 between Terminal Island and San Pedro PM 0.4/2.1
Contractor Name: Skanska
Contractor Address: 1995 Agua Mansa Rd, Riverside, CA 92509
Resident Engineer: Sam Gallardo Structure Rep.: Sami Deeb
DIME Sample ID: 2026-07-28-5
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: 07/28/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/28/2026
The quantity of what the sample constitutes: 14
A brief description of the sample: 7/8" A563 Gr DH Hex Nut
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): 21050570
Nut Mfg. Lot Number(s): N0171-21050570
Washer Mfg. Lot Number(s): N/A
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: A563
Washer Specification: N/A
Finish: HDG w/ Wax & Dye
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): 0
Lubricant Requirements(s): 0
Washer Inner Diameter(s): 0
DIME Test ID: 2026-07-28-5-1
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: 08/25/2026
Date Tested: 08/24/2026
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:
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Sample No.
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1A
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Rocap Number
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no data
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|
Heat Number(s)
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no data
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Mfg. Lot Number
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N0171-21050570
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Finish Coating
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ASTM F2329 - Hot Dip
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Product Markings
|
DMC DH
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Size
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0.875 in
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Bolt Length
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no data in
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Measurement Average
|
2.3 mils
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DIME Test ID: 2026-07-28-5-2
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: 08/25/2026
Date Tested: 08/24/2026
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
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1
|
| Sample | Bolt Mfg. Lot Number | Size (in) | Peak Load (lbf) | Peak Load (kN) | Wedge Angle (deg) | Comments | Tested By | | 1A | N0171-21050570 | 0.875 | 80850 | 0 | 0 | Nut Proof lLoad | Kleinfelder |
| |
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UTM
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NA
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Temperature
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72 f
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