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Sample Record for 2021-04-21-3

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

Project Information

Project ID: 214579 DEA: 010B0904 EFIS: 0100020444 QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-8.2/8.7
Work Description: BRIDGE REPLACEMENT
Location Description: DEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Ryan Dunne Structure Rep.: Bryan Keene

Sample Information

DIME Sample ID: 2021-04-21-3
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Sacramento Field Laboratory
Sample Organization Contact: (916) 227-7263
Type of Sample: Acceptance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 04/21/2021
Date that the sample was received by the laboratory/organization performing the testing: 04/26/2021
The quantity of what the sample constitutes: 70
A brief description of the sample: 1inch A563 Grade A Nuts Welded to Washers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Thompson Metal Fab

Material Information

Rocap Number(s):
Heat Number(s): B18120740
Nut Mfg. Lot Number(s): N2019071562GH
Washer Mfg. Lot Number(s):
Bolt Specification: N/A
Bolt Length(s):
Nut Specification: A563 Gr A
Washer Specification: N/A
Finish: HDG
Diameter/Size: 1
Bolt Mfg. Lot Number:
Rocap Test Requirement(s): No
Lubricant Requirements(s): No

Test Results

Test 1 of 6

DIME Test ID: 2021-04-21-3-1
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 04/28/2021
Date Tested: 12/31/1969
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 N2019071562GH
Finish Coating ASTM F2329 - Hot Dip
Product Markings NA
Size 1 in
Gage Type NA

Test 2 of 6

DIME Test ID: 2021-04-21-3-2
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 04/28/2021
Date Tested: 12/31/1969
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 N2019071562GH
Finish Coating ASTM F2329 - Hot Dip
Product Markings NA
Size 1 in
Gage Type NA

Test 3 of 6

DIME Test ID: 2021-04-21-3-3
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 04/28/2021
Date Tested: 12/31/1969
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 N2019071562GH
Finish Coating ASTM F2329 - Hot Dip
Product Markings NA
Size 1 in
Gage Type NA

Test 4 of 6

DIME Test ID: 2021-04-21-3-4
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 04/28/2021
Date Tested: 12/31/1969
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 N2019071562GH
Finish Coating ASTM F2329 - Hot Dip
Product Markings NA
Size 1 in
Bolt Length no data in
Measurement Average 4.84 mils

Test 5 of 6

DIME Test ID: 2021-04-21-3-5
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 04/28/2021
Date Tested: 12/31/1969
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 N2019071562GH
Finish Coating ASTM F2329 - Hot Dip
Product Markings NA
Size 1 in
Bolt Length no data in
Measurement Average 5.57 mils

Test 6 of 6

DIME Test ID: 2021-04-21-3-6
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 04/28/2021
Date Tested: 12/31/1969
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 N2019071562GH
Finish Coating ASTM F2329 - Hot Dip
Product Markings NA
Size 1 in
Bolt Length no data in
Measurement Average 6.09 mils

Tests Assigned to this Sample

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