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Sample Record for 2021-12-03-3

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

Project Information

Project ID: 215371 DEA: 042W1204 EFIS: 0421000139 QA Service Level: 1
DIST-CO-RTE-PM: 04-CC,CC/MRN-580-6.9/7.8, 6.9, 7.8, 02, 5
Work Description: REPLACEMENT OF GUSSET PLATES AT VARIOUS LOCATIONS
Location Description: Richmond San Rafael Bridge
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510
Resident Engineer: Behzad Halali Structure Rep.: William Sommer

Sample Information

DIME Sample ID: 2021-12-03-3
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: 12/03/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/03/2021
The quantity of what the sample constitutes: 61
A brief description of the sample: HS Bolt Assembly
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Richmond San Rafael Bridge
The fabricator/manufacturer/facility name: LeJeune Bolt Company

Material Information

Rocap Number(s):
Heat Number(s): X4168
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s): D9196
Bolt Specification: na
Bolt Length(s):
Nut Specification: na
Washer Specification: F436
Finish: Geomet
Diameter/Size: 1-1/8 diam
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test results on following page(s): 5

Test Results

Test 1 of 5

DIME Test ID: 2021-12-03-3-1
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 12/13/2021
Date Tested: 12/09/2021
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:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number D9196
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings F436 P
Size 1.125 in
Bolt Length no data in
Measurement Average 0.88 mils

Test 2 of 5

DIME Test ID: 2021-12-03-3-2
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 12/13/2021
Date Tested: 12/09/2021
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:
Sample No. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number D9196
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings F436 P
Size 1.125 in
Bolt Length no data in
Measurement Average 0.54 mils

Test 3 of 5

DIME Test ID: 2021-12-03-3-3
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 12/13/2021
Date Tested: 12/09/2021
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:
Sample No. 1C
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number D9196
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings F436 P
Size 1.125 in
Bolt Length no data in
Measurement Average 0.58 mils

Test 4 of 5

DIME Test ID: 2021-12-03-3-4
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 12/13/2021
Date Tested: 12/09/2021
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:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number D9196
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings F436 P
Size 1.125 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 39.3
Spacing Ok

Test 5 of 5

DIME Test ID: 2021-12-03-3-5
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 12/13/2021
Date Tested: 12/09/2021
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:
Sample No. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number D9196
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings F436 P
Size 1.125 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 38.95
Spacing Ok