Project Information

Project ID: 215032 DEA: 030H5204 EFIS: 0315000202 QA Service Level: 1

DIST-CO-RTE-PM: 03-ED-50-0.0/80.4

Work Description: INSTALL CMS, CAMERA SYSTEMS AND TMS ELEMENTS.

Location Description: EL DORADO COUNTY AT VARIOUS LOCATIONS FROM THE SACRAMENTO COUNTY LINE TO CALIFORNIA/NEVADA STATE LINE

Contractor Name: TIM PAXIN'S PACIFIC EXCAVATION INC

Contractor Address: 9796 KENT STREET, ELK GROVE CA 95624

Resident Engineer: Juanah Koker Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-06-10-9

TL Number from the TL Form:

Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office

Sample Organization Contact: (916) 2058871

Type of Sample: Quality Assurance

Type of Material: SMTL TM3 - Fastener Assembly

Sample Taken Date: 06/10/2021

Date that the sample was received by the laboratory/organization performing the testing: 06/14/2021

The quantity of what the sample constitutes: 21

A brief description of the sample: High Strength Fastener Assemblies

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: SSP Fort Worth

Material Information

Rocap Number(s): 5/21/21A

Heat Number(s): 101590

Nut Mfg. Lot Number(s): N/A

Washer Mfg. Lot Number(s): 12880

Bolt Specification: N/A

Bolt Length(s):

Nut Specification: N/A

Washer Specification: F436

Finish: Galvanized

Diameter/Size: 3/4-10

Bolt Mfg. Lot Number:

Rocap Test Requirement(s):

Lubricant Requirements(s):

Test Results

Test 1 of 2

DIME Test ID: 2021-06-10-9-1

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: 06/16/2021

Date Tested: 06/16/2021

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	12880
Finish Coating	ASTM F2329 - Hot Dip
Product Markings	WS
Size	.75 in
Bolt Length	no data in
Measurement Average	2.9 mils

Test 2 of 2

DIME Test ID: 2021-06-10-9-2

Test Method: ASTM E18-15: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)