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Sample Record for 2017-07-28-14

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

Project Information

Project ID: 212568 DEA: 022H1504 EFIS: 0216000054 MINOR: 02A1611 QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-3-
Work Description: Yreka Wash Basin Canopy
Location Description:
Contractor Name: Timberworks
Contractor Address: 509 S Mt. Shasta Blvd, Mt. Shasta, CA 96067
Resident Engineer: Bob Thompson Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2017-07-28-14
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: (510) 385-8178
Type of Sample: Verification
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 07/28/2017
Date that the sample was received by the laboratory/organization performing the testing: 07/28/2017
The quantity of what the sample constitutes: 33
A brief description of the sample: 1554 / 36 Anchor Bolts
From where was the sample collected: Fabricator
Laboratory sample identification: S08-015-17
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cascade

Material Information

Rocap Number(s):
Heat Number(s): 120815
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: 1554 /36
Bolt Length(s): 25
Nut Specification: none
Washer Specification: none
Finish: Plain
Diameter/Size: 1.125"
Bolt Mfg. Lot Number: 1506152-73
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Results

Test 1 of 1

DIME Test ID: 2017-07-28-14-2
Test Method: ASME B1.2-83r01: (Ring Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Ring Gage)
Verified Date: 08/02/2017
Date Tested: 08/02/2017
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: paul.lukkarila@dot.ca.gov
Organization Phone: (916) 227-7253
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1A
Rocap Number no data
Heat Number(s) 120815
Mfg. Lot Number no data
Finish Coating Plain
Product Markings BLUE PAINT
Size no data in
Bolt Length 25 in
Gage Type Fail (No Go)

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
2017-07-28-14-1ASME B1.2-83r01: (Ring Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Ring Gage)08/02/201708/02/2017Glen WeldonCT HQ - Sacramento Structural Materials Testing LaboratoryGlen Weldon