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Sample Record for 2024-08-21-13

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

Project Information

Project ID: 994816 DEA: 010E11U4 EFIS: 0123000069 QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-1-31.1/31.6
Work Description: STRUCTURAL CONC BRIDGE, TEMP BRIDGE AND BAR REINFORCING STEEL.
Location Description: MENDOCINO COUNTY NEAR ELK FROM 0.2 MILE SOUTH OF ELK CREEK BRIDGE TO 0.2 MILE NORTH OF ELK CREEK BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 1324 S. State Street, Ukiah, CA 95482
Resident Engineer: Mojtaba Mosallai Structure Rep.: Mostafa Bayoumi

Sample Information

DIME Sample ID: 2024-08-21-13
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 08/21/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/26/2024
The quantity of what the sample constitutes: 2
A brief description of the sample: 1-3/4" A563 Grade DH Heavy Hex Nut
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: C & K Johnson Industries

Material Information

Rocap Number(s):
Heat Number(s): 20916860
Nut Mfg. Lot Number(s): BVKG
Washer Mfg. Lot Number(s):
Bolt Specification: ASTM F1554 Grade 105
Bolt Length(s):
Nut Specification: A563
Washer Specification: F436
Finish: HDG
Diameter/Size: 1.75
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
Test results on following page(s): 4

Test Results

Test 1 of 4

DIME Test ID: 2024-08-21-13-1
Test Method: ASME B1.2-83r17: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 09/05/2024
Date Tested: 09/03/2024
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 BVKG
Finish Coating ASTM F2329 - Hot Dip
Product Markings DH D/N 2H
Size 1.75 in
Gage Type Fail (Go)

Test 2 of 4

DIME Test ID: 2024-08-21-13-2
Test Method: ASME B1.2-83r17: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 09/05/2024
Date Tested: 09/03/2024
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 BVKG
Finish Coating ASTM F2329 - Hot Dip
Product Markings DH D/N 2H
Size 1.75 in
Gage Type Fail (Go)

Test 3 of 4

DIME Test ID: 2024-08-21-13-3
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: 09/05/2024
Date Tested: 09/03/2024
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 BVKG
Finish Coating ASTM F2329 - Hot Dip
Product Markings DH D/N 2H
Size 1.75 in
Bolt Length no data in
Measurement Average 6.32 mils

Test 4 of 4

DIME Test ID: 2024-08-21-13-4
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: 09/05/2024
Date Tested: 09/03/2024
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 BVKG
Finish Coating ASTM F2329 - Hot Dip
Product Markings DH D/N 2H
Size 1.75 in
Bolt Length no data in
Measurement Average 5.43 mils