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Sample Record for 2020-11-05-3

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

Project Information

Project ID: 214787 DEA: 032H0804 EFIS: 0317000059 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-160-L3.9
Work Description: INSTALL CHANGEABLE MESSAGE AND CAMERA SYSTEMS, & PLACE SIGN STRUCTURE.
Location Description: SACRAMENTO COUNTY NEAR ANTIOCH AT 3.9 MILES NORTH OF CONTRA COSTA COUNTY LINE
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Howard Giang Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2020-11-05-3
TL Number from the TL Form: na
Sample Submitted By Organization: CT QASI - Bay Area Field Laboratory
Sample Organization Contact: (707) 649-5453
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 11/05/2020
Date that the sample was received by the laboratory/organization performing the testing: 11/16/2020
The quantity of what the sample constitutes: 810
A brief description of the sample: Anchor Bolt Hardware 2-1/2" (Retest)
From where was the sample collected: Fabricator
Laboratory sample identification: na
Structure unique identifier:
Structure name: na
The fabricator/manufacturer/facility name: Universal Industrial Sales

Material Information

Rocap Number(s): na
Heat Number(s): 201548
Nut Mfg. Lot Number(s): DECN
Washer Mfg. Lot Number(s): na
Bolt Specification: na
Bolt Length(s): na
Nut Specification: 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

Test 1 of 8

DIME Test ID: 2020-11-05-3-1
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Gage Type Pass

Test 2 of 8

DIME Test ID: 2020-11-05-3-2
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Gage Type Pass

Test 3 of 8

DIME Test ID: 2020-11-05-3-3
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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. 1C
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Gage Type Pass

Test 4 of 8

DIME Test ID: 2020-11-05-3-4
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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. 1D
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Gage Type Pass

Test 5 of 8

DIME Test ID: 2020-11-05-3-5
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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. 1E
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Gage Type Pass

Test 6 of 8

DIME Test ID: 2020-11-05-3-6
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 25.9
Spacing Ok

Test 7 of 8

DIME Test ID: 2020-11-05-3-7
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 26.4
Spacing Ok

Test 8 of 8

DIME Test ID: 2020-11-05-3-8
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 11/18/2020
Date Tested: 11/18/2020
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. 1C
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number DECN
Finish Coating Plain
Product Markings 2H DH D/N
Size 2.5 in
Bolt Length no data in
Hardness Reading Scale C Scale
Hardness Reading Average 26.38
Spacing Ok

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.