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Sample Record for 2019-12-16-12

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

Project Information

Project ID: 208945 DEA: 07288604 EFIS: 0700021080 COOP: 074663 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-6.0-9.4
Work Description: Gerald Desmond Bridge Replacement - A Design Build project. IQA samples will be selected by Port/Caltrans representatives and sent to Translab for testing.
Location Description: Port of Long Beach (District 7)
Contractor Name: Shimmick/FCC/Impregilo (SFI) JV
Contractor Address: 11 Golden Shore, Suite 330, Long Beach, CA 90802
Resident Engineer: Structure Rep.: Sami Deeb

Sample Information

DIME Sample ID: 2019-12-16-12
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: 12/16/2019
Date that the sample was received by the laboratory/organization performing the testing: 12/19/2019
The quantity of what the sample constitutes: 1
A brief description of the sample: A490 Bolt
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LeJeune Bolt Company

Material Information

Rocap Number(s): L1413194
Heat Number(s): 75067668
Nut Mfg. Lot Number(s): 28846-6214661005Z
Washer Mfg. Lot Number(s): 0115-716Z
Bolt Specification: A490
Bolt Length(s): 5-1/4"
Nut Specification: A563 DH
Washer Specification: F436-3
Finish: Geomet
Diameter/Size: 1-1/4"
Bolt Mfg. Lot Number: 042419-1BMZ
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test results on following page(s): 5

Test Results

Test 1 of 5

DIME Test ID: 2019-12-16-12-1
Test Method: ASTM F606-14a: Standard Test Methods for Determining the Mechanical Properties of Externally and Internally Threaded Fasteners, Washers, Direct Tension Indicators, and Rivets (Proof Load with Wedge)
Verified Date: 01/07/2020
Date Tested: 01/03/2020
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: A490 Wedge Tensile
Test Result Compliance:
Additional Comments When Verified:
Number of Bolt Samples 1
SampleBolt Mfg. Lot NumberSize (in)Peak Load (lbf)Peak Load (kN)Wedge Angle (deg)CommentsTested By
1A042419-1BM1.2500151652674.586.00A490 Wedge Tensilespaine
UTM 450kip
Temperature no data

Test 2 of 5

DIME Test ID: 2019-12-16-12-2
Test Method: ASTM F606-14a: Standard Test Methods for Determining the Mechanical Properties of Externally and Internally Threaded Fasteners, Washers, Direct Tension Indicators, and Rivets (Proof Load)
Verified Date: 01/07/2020
Date Tested: 01/03/2020
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: Nut Proof Load
Test Result Compliance:
Additional Comments When Verified:
Number of Samples 1
SampleBolt Mfg. Lot NumberSize (in)Peak Load (lbf)Peak Load (kN)CommentsTested By
1A28846-6214661005170657Nut Proof Loadspaine
UTM 450kip
Temperature 72 f

Test 3 of 5

DIME Test ID: 2019-12-16-12-3
Test Method: ASME B1.2-83r01: (Ring Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Ring Gage)
Verified Date: 01/07/2020
Date Tested: 01/06/2020
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:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 042419-1BM
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings BBC A490
Size 1.25 in
Bolt Length 5.25 in
Gage Type Pass

Test 4 of 5

DIME Test ID: 2019-12-16-12-4
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 01/07/2020
Date Tested: 01/06/2020
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:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 28846-6214661005
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings DH3 U
Size 1.25 in
Gage Type Pass

Test 5 of 5

DIME Test ID: 2019-12-16-12-5
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 01/07/2020
Date Tested: 01/06/2020
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:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 0115-716
Finish Coating ASTM F1136 - Dachromet or Geomet
Product Markings F436-3 P
Size 1.25 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 42
Spacing Ok