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Sample Record for 2022-02-10-11

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

Project Information

Project ID: 213741 DEA: 07325704 EFIS: 0716000089 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-1.7
Work Description: BUILDING CONSTRUCTION IN LOS ANGELES COUNTY IN SANTA FE SPRINGS AT 14044 FREEWAY DRIVE.
Location Description: Santa Fe Springs, At 14044 Freeway Drive.
Contractor Name: AWI Builders Inc
Contractor Address: 7831 Paramount Bl, Pico Rivera Ca 90660
Resident Engineer: Mashhur Ali Structure Rep.: Nelson Parada

Sample Information

DIME Sample ID: 2022-02-10-11
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: 02/10/2022
Date that the sample was received by the laboratory/organization performing the testing: 02/15/2022
The quantity of what the sample constitutes: 768
A brief description of the sample: 7/8"
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cordova Bolt

Material Information

Rocap Number(s):
Heat Number(s): 32122230
Nut Mfg. Lot Number(s): n/a
Washer Mfg. Lot Number(s): 0721-890
Bolt Specification: n/a
Bolt Length(s): n/a
Nut Specification: n/a
Washer Specification: ASTM F436
Finish: Zinc
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: n/a
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2022-02-10-11-1
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 03/28/2022
Date Tested: 03/14/2022
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 0721-890
Finish Coating Plain
Product Markings F436 TSI
Size .875 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 39.8
Spacing Ok

Test 2 of 3

DIME Test ID: 2022-02-10-11-2
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 03/28/2022
Date Tested: 03/14/2022
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 0721-890
Finish Coating Plain
Product Markings F436 TSI
Size .875 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 38.85
Spacing Ok

Test 3 of 3

DIME Test ID: 2022-02-10-11-3
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 03/28/2022
Date Tested: 03/14/2022
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 0721-890
Finish Coating Plain
Product Markings F436 TSI
Size .875 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 40.35
Spacing Ok