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Testing Report for 2020-12-23-1-2

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

Project Information

DEA: 120P5204
EFIS: 1215000137
Project ID: 214888
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-22,57-R9.4/L9.8,10.9/11.4
Work Description: REPLACE CONC BARRIER & SIGN PANEL; & MODIFY LIGHTING SYSTEM.
Location Description: ORANGE COUNTY IN ORANGE ON ROUTE 22 FROM LEWIS STREET OVERCROSSING TO 0.1 MILE WEST OF THE CITY DRIVE UNDERCROSSING AND ON ROUTE 57 FROM 0.3 MILE SOUTH OF CHAPMAN AVENUE UNDERCROSSING TO 0.4 MILE SOUTH OF ORANGEWOOD AVENUE UNDERCROSSING
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Elie Najm
Structure Rep.: Bijan Ronagh-Langroodi

Sample Information

DIME Sample ID: 2020-12-23-1
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Verification
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 12/23/2020
Date that the sample was received by the laboratory/organization performing the testing: 1/4/2021
The quantity of what the sample constitutes: 48 ea.
A brief description of the sample: Anchor Bolt Assembly
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: EDSCO

Material Information

Rocap Number(s):
Heat Number(s): 3101507
Nut Mfg. Lot Number(s): XYY2 HDG Nut XSF2 Plain Nut
Washer Mfg. Lot Number(s): 6186
Bolt Specification: F1554 Gr55
Bolt Length(s): 4'-4"
Nut Specification: A194 Grade 2H
Washer Specification: F436
Finish:
Diameter/Size: 3"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2020-12-23-1-2
Test Method: ASME B1.2-83r01: (Ring Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Ring Gage)
Date Tested: 1/4/2021
Verified Date: 1/6/2021
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 :

Submitted Test Results

Sample No.: 1A
Rocap Number: no data
Heat Number(s): 3101507
Mfg. Lot Number: no data
Finish Coating: Plain and ASTM F2329 - Hot Dip
Product Markings: YELLOW
Size: 3 in
Bolt Length: 52 in
Gage Type: Pass