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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.: Brian Cinkutis

Sample Information

DIME Sample ID: 2021-04-21-3
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
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: 916-227-7257
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: 916-227-7257
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: 916-227-7257
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: 916-227-7257
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: 916-227-7257
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: 916-227-7257
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