Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210673 DEA: 042640F4 EFIS: 0400020132 COOP: 042308A3
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON--
Work Description:
Location Description:
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Gina Choi Structure Rep.: Brian Beaudoin
DIME Sample ID: 2020-09-18-1
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: 09/18/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2020
The quantity of what the sample constitutes: 42
A brief description of the sample: 2 1/4 F436 Flat Washer Plain
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): na
Heat Number(s): 194054
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s): 5770
Bolt Specification: na
Bolt Length(s):
Nut Specification: na
Washer Specification: F436
Finish: Plain
Diameter/Size: 2 1/4"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
DIME Test ID: 2020-09-18-1-1
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
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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5770
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Finish Coating
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Plain
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Product Markings
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WS
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Size
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2.25 in
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Bolt Length
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no data in
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Hardness Reading Scale
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C Scale
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Hardness Reading Average
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39.55
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Spacing
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Ok
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