Project Information

Project ID: 213737 DEA: 07289104 EFIS: 0700021123 QA Service Level: 1

DIST-CO-RTE-PM: 07-LA-405-11.9/13.2

Work Description: Rehabilitate the existing Commercial Vehicle Enforcement Facility.

Location Description: LOS ANGELES COUNTY IN CARSON FROM DEL AMO BOULEVARD OVER CROSSING TO VERMONT AVENUE (190TH) UNDER CROSSING.

Contractor Name: POWELL CONSTRUCTORS, INC.

Contractor Address: 8555 Banana Avenue, Fontana, CA 92335

Resident Engineer: Samuel Gallardo Structure Rep.: Bernabe Contreras Jr

Sample Information

DIME Sample ID: 2020-07-28-11

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: 07/28/2020

Date that the sample was received by the laboratory/organization performing the testing: 07/31/2020

The quantity of what the sample constitutes: 44

A brief description of the sample: 1 1/4 -7 A563 GR DH HV HX Nut

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Nucor

Material Information

Rocap Number(s): B418485A N433649B WD6958 B392101A N425659A WD8070 B385001A N425659A WD8070

Heat Number(s): 100100612

Nut Mfg. Lot Number(s): 433649B

Washer Mfg. Lot Number(s): n/a

Bolt Specification: n/a

Bolt Length(s): n/a

Nut Specification: ASTM A563

Washer Specification: n/a

Finish: Black

Diameter/Size: 1 1/4-7"

Bolt Mfg. Lot Number: n/a

Rocap Test Requirement(s):

Lubricant Requirements(s):

Test Results

Test 1 of 2

DIME Test ID: 2020-07-28-11-1

Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)

Verified Date: 08/06/2020

Date Tested: 08/05/2020

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	433649B
Finish Coating	Plain
Product Markings	DH N
Size	1.25 in
Gage Type	Pass

Test 2 of 2

DIME Test ID: 2020-07-28-11-2

Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)