Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002104 DEA: 07369604 EFIS: 0719000376
QA Service Level: 1
DIST-CO-RTE-PM: 07-UNKNOWN--unknown
Work Description:
Location Description:
Contractor Name: Peterson Chase Construction
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Nzhde Matecosyan Structure Rep.: Adriana Pimienta
DIME Sample ID: 2026-09-16-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2026
The quantity of what the sample constitutes: 1500
A brief description of the sample: A563-DH HDG Nut
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS
Rocap Number(s): N/A
Heat Number(s): 20722850
Nut Mfg. Lot Number(s): E275S1X
Washer Mfg. Lot Number(s): N/A
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: ASTM A563
Washer Specification: N/A
Finish: MG
Diameter/Size: 1-1/8"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): NONE
Lubricant Requirements(s): SL LUBE ONLY
Washer Inner Diameter(s): NONE
Bolt Mill Supplier:
Nut Mill Supplier:
Washer Mill Supplier:
DIME Test ID: 2026-09-16-4-1
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: 10/08/2026
Date Tested: 10/07/2026
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.
|
1A
|
|
Rocap Number
|
no data
|
|
Heat Number(s)
|
no data
|
|
Mfg. Lot Number
|
E275S1X
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
LOGO LE USA DH
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3.4 mils
|
DIME Test ID: 2026-09-16-4-2
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: 10/08/2026
Date Tested: 10/07/2026
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.
|
1B
|
|
Rocap Number
|
no data
|
|
Heat Number(s)
|
no data
|
|
Mfg. Lot Number
|
E275S1X
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
LOGO LE USA DH
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
4.1 mils
|
DIME Test ID: 2026-09-16-4-3
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: 10/08/2026
Date Tested: 10/07/2026
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
|
E275S1X
|
|
Finish Coating
|
ASTM B695 - Mech Galv
|
|
Product Markings
|
LOGO LE USA DH
|
|
Size
|
1.125 in
|
|
Bolt Length
|
no data in
|
|
Measurement Average
|
3.5 mils
|
DIME Test ID: 2026-09-16-4-4
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: 10/08/2026
Date Tested: 09/28/2026
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: Nut Proof Load
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 | E275S1X | 1.125 | 133525 | 0 | 0 | Nut Proof Load | Kleinfelder | | 1B | E275S1X | 1.125 | 133525 | 0 | 0 | Nut Proof Load | Kleinfelder | | 1C | E275S1X | 1.125 | 133525 | 0 | 0 | Nut Proof Load | Kleinfelder |
| |
|
UTM
|
NA
|
|
Temperature
|
72 f
|
