Sample Record for 2026-09-02-13
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000412 DEA: 051K5204 EFIS: 0518000216
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-154-0/32.84
Work Description: Drainage System Restoration
Location Description: SR 154 Santa Barbara County
Contractor Name: TSI ENGINEERING, INC
Contractor Address: 4600 Roseville Road, Suite140, North Highland, CA 95660
Resident Engineer: Alfredo Caldarone Structure Rep.: John Gentry
Sample Information
DIME Sample ID: 2026-09-02-13
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: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/02/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/07/2026
The quantity of what the sample constitutes: 7
A brief description of the sample: 3/4" ROCAP Assy
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales Inc.
Material Information
Rocap Number(s): TT0204747
Heat Number(s): 10896290, 21000540, A82865
Nut Mfg. Lot Number(s): 42753-S
Washer Mfg. Lot Number(s): E8203
Bolt Specification: A325
Bolt Length(s): 5"
Nut Specification: A563-DH
Washer Specification: F436
Finish: MG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: M6022
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
Bolt Mill Supplier: NA
Nut Mill Supplier: NA
Washer Mill Supplier: NA
Test Results
Test
DIME Test ID: 2026-09-02-13-1
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.
