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Sample Record for 2023-04-18-14

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

Project Information

Project ID: 213903 DEA: 043G4544 EFIS: 0412000054 QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA,SM-92-R14.4/R18.8,R0.0/R.2.4
Work Description: Repair Spalled Concrete Columns and Spandrel Beams
Location Description: San Mateo-Hayward Bridge
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Kingston Atako Structure Rep.: Lisa Chang-Bridges

Sample Information

DIME Sample ID: 2023-04-18-14
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: 04/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/21/2023
The quantity of what the sample constitutes: 134
A brief description of the sample: F436 Washer Square Bevel
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: XKT Engineering

Material Information

Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s): 3800016174
Bolt Specification: x
Bolt Length(s):
Nut Specification: x
Washer Specification: F436
Finish: HDG
Diameter/Size: 1/2
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2023-04-18-14-1
Test Method: ASTM B499-09r21: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 05/11/2023
Date Tested: 04/24/2023
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 3800016174
Finish Coating ASTM F2329 - Hot Dip
Product Markings W
Size .5 in
Bolt Length no data in
Measurement Average 5.62 mils

Test 2 of 2

DIME Test ID: 2023-04-18-14-2
Test Method: ASTM B499-09r21: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 05/11/2023
Date Tested: 04/24/2023
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. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 3800016174
Finish Coating ASTM F2329 - Hot Dip
Product Markings W
Size .5 in
Bolt Length no data in
Measurement Average 4.31 mils