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Sample Record for 2023-08-04-21

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

Project Information

Project ID: 215421 DEA: 042K9504 EFIS: 0417000057 QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-14.4/14.4
Work Description: CONSTRUCT MATERIAL TESTING LABORATORY BUILDING.
Location Description: ALAMEDA COUNTY IN LIVERMORE AT 2201 KITTY HAWK ROAD
Contractor Name: Walsh Construction Company II, LLC (Walsh) - Dominic Fung
Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520
Resident Engineer: Amir-Fardin Sadeghi-Nedjad Structure Rep.: John Parecadan

Sample Information

DIME Sample ID: 2023-08-04-21
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Department Acceptance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 08/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/08/2023
The quantity of what the sample constitutes: 180
A brief description of the sample: 3/4" A563 Nuts
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LB Construction

Material Information

Rocap Number(s):
Heat Number(s): 223575
Nut Mfg. Lot Number(s): 37174-223575
Washer Mfg. Lot Number(s):
Bolt Specification: na
Bolt Length(s):
Nut Specification: A563 DH
Washer Specification: na
Finish: Black
Diameter/Size: 3/4"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2023-08-04-21-1
Test Method: ASTM F606-21: Standard Test Methods for Determining the Mechanical Properties of Externally and Internally Threaded Fasteners, Washers, Direct Tension Indicators, and Rivets (Proof Load)
Verified Date: 08/10/2023
Date Tested: 08/10/2023
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: Proof Load
Test Result Compliance:
Additional Comments When Verified:
Number of Samples 1
SampleBolt Mfg. Lot NumberSize (in)Peak Load (lbf)Peak Load (kN)CommentsTested By
1A63443Proof Load
UTM 450kip
Temperature 72 f

Test 2 of 3

DIME Test ID: 2023-08-04-21-2
Test Method: ASME B1.2-83r17: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 08/10/2023
Date Tested: 08/10/2023
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 37174-223575
Finish Coating Plain
Product Markings U DH
Size 0.75 in
Gage Type Pass

Test 3 of 3

DIME Test ID: 2023-08-04-21-3
Test Method: ASME B1.2-83r17: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Verified Date: 08/10/2023
Date Tested: 08/10/2023
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 37174-223575
Finish Coating Plain
Product Markings U DH
Size 0.75 in
Gage Type Pass