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Sample Record for 2026-08-10-7

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 1001197 DEA: 07319604 EFIS: 0716000025 QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-1,101-21.3/21.9,R34.9/R36.1
Work Description: REMOVE AND CONSTRUCT BRIDGE.
Location Description: VENTURA COUNTY ON ROUTE 1 FROM 1.8 MILES NORTH OF ROUTE 1/33 SEPARATION TO 2.0 MILES SOUTH OF A LEASE CANYON ROAD AND ON ROUTE 101 FROM 0.4 MILE NORTH OF DULAH ROAD UNDERCROSSING TO SAN MIGUELITO ROAD UNDERCROSSING
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 BRISTOL STREET, SUITE D204, COSTA MESA, CA 92626
Resident Engineer: Ranjit Singh Structure Rep.: Aziz Maghsoudloo

Sample Information

DIME Sample ID: 2026-08-10-7
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: 08/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/14/2026
The quantity of what the sample constitutes: 303
A brief description of the sample: 1" x 40" Gr 105 Double End Stud Anchor Bolts
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo

Material Information

Rocap Number(s): N/A
Heat Number(s): Bolt, A254986 Nut, 1000234596 Washer, 190250877
Nut Mfg. Lot Number(s): 1000234596
Washer Mfg. Lot Number(s): 190250877
Bolt Specification: F1554 Gr 105
Bolt Length(s): 40"
Nut Specification: A563
Washer Specification: F436
Finish: Galvanized
Diameter/Size: 1"
Bolt Mfg. Lot Number: A254986
Rocap Test Requirement(s): No
Lubricant Requirements(s): No
Washer Inner Diameter(s): One point three inches
Test results on following page(s): 3

Test Results

Test

DIME Test ID: 2026-08-10-7-1
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: 2026-08-10-7-2
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.

Test

DIME Test ID: 2026-08-10-7-3
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.