Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2023-08-08-3
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: 08/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/08/2023
The quantity of what the sample constitutes: 20
A brief description of the sample: 5/8 F436 Washers
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LB Construction
Rocap Number(s):
Heat Number(s): 292932
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s): 0719-205
Bolt Specification: na
Bolt Length(s):
Nut Specification: na
Washer Specification: F436
Finish: Black
Diameter/Size: 5/8
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
DIME Test ID: 2023-08-08-3-1
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
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:
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Sample No.
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1A
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Rocap Number
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no data
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Heat Number(s)
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no data
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Mfg. Lot Number
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0719-205
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Finish Coating
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Plain
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Product Markings
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TSI F436
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Size
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0.625 in
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Bolt Length
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no data in
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Hardness Reading Scale
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C Scale
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Hardness Reading Average
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39.9
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Spacing
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Ok
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