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Sample Record for 2021-04-27-5

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

Project Information

Project ID: 214858 DEA: 11424904 EFIS: 1116000094 QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5,8,15,52,54-Var
Work Description: Install roadside signs.
Location Description: 11-SD-5, 8, 15, 52, 54, etc.-Var.
Contractor Name: BC Rentals Inc, dba BC Traffic Specialist
Contractor Address: 638 W Southern Ave,, Orange, CA 92865
Resident Engineer: Genaro Genel Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-04-27-5
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: 04/27/2021
Date that the sample was received by the laboratory/organization performing the testing: 04/27/2021
The quantity of what the sample constitutes: 810
A brief description of the sample: A563 DH Anchor Bolt Hardware
From where was the sample collected: Fabricator
Laboratory sample identification: na
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales Inc

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 3

DIME Test ID: 2021-04-27-5-1
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 05/20/2021
Date Tested: 05/07/2021
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 29.32
Spacing Ok

Test 2 of 3

DIME Test ID: 2021-04-27-5-2
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 05/20/2021
Date Tested: 05/07/2021
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 25.8
Spacing Ok

Test 3 of 3

DIME Test ID: 2021-04-27-5-3
Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Verified Date: 05/20/2021
Date Tested: 05/07/2021
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 28.05
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.