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Sample Record for 2020-09-18-8

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

Project Information

Project ID: 210673 DEA: 042640F4 EFIS: 0400020132 COOP: 042308A3 QA Service Level: 1
DIST-CO-RTE-PM: 04-SON--
Work Description:
Location Description:
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Gina Choi Structure Rep.: Brian Beaudoin

Sample Information

DIME Sample ID: 2020-09-18-8
TL Number from the TL Form: na
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 09/18/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2020
The quantity of what the sample constitutes: 540
A brief description of the sample: 2 1/2" A563-DH Hex Nut Plain
From where was the sample collected: Fabricator
Laboratory sample identification: na
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales

Material Information

Rocap Number(s): na
Heat Number(s): 188907
Nut Mfg. Lot Number(s): DEAM
Washer Mfg. Lot Number(s): na
Bolt Specification: na
Bolt Length(s): na
Nut Specification: A563- A563-DH
Washer Specification: na
Finish: Plain
Diameter/Size: 2 1/2"
Bolt Mfg. Lot Number: na
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Test results on following page(s): 8

Test Results

Test 1 of 8

DIME Test ID: 2020-09-18-8-1
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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 DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Gage Type Pass

Test 2 of 8

DIME Test ID: 2020-09-18-8-2
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Gage Type Pass

Test 3 of 8

DIME Test ID: 2020-09-18-8-3
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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. 1C
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Gage Type Pass

Test 4 of 8

DIME Test ID: 2020-09-18-8-4
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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. 1D
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Gage Type Pass

Test 5 of 8

DIME Test ID: 2020-09-18-8-5
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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. 1E
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Gage Type Pass

Test 6 of 8

DIME Test ID: 2020-09-18-8-6
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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 DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 24.52
Spacing Ok

Test 7 of 8

DIME Test ID: 2020-09-18-8-7
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 24.98
Spacing Ok

Test 8 of 8

DIME Test ID: 2020-09-18-8-8
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 10/08/2020
Date Tested: 10/07/2020
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. 1C
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DEAM
Finish Coating Plain
Product Markings DH D/N 2H
Size 2.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 24.86
Spacing Ok