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Testing Report for 2021-01-21-5-10

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

Project Information

DEA: STOCK
EFIS: STOCK
Project ID: 88888
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-01-21-5
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: 1/21/2021
Date that the sample was received by the laboratory/organization performing the testing: 1/27/2021
The quantity of what the sample constitutes: 3
A brief description of the sample: ASTM F1554 Grade 105 HS Anchor Bolts
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: A and M Nut and Bolt

Material Information

Rocap Number(s):
Heat Number(s): 58039942-05 6215287602 183679
Nut Mfg. Lot Number(s): 33708-6215287602
Washer Mfg. Lot Number(s): T27318999
Bolt Specification: ASTM F1554 Grade 105
Bolt Length(s): 40"
Nut Specification: ASTM A194 Heavy Hex GR 2H
Washer Specification: ASTM F436 MG
Finish: HDG
Diameter/Size: 1" x 40"
Bolt Mfg. Lot Number: 51721-PPO
Rocap Test Requirement(s): NA
Lubricant Requirements(s): NA

Test Information

DIME Test ID: 2021-01-21-5-10
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 2/4/2021
Verified Date: 2/4/2021
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.: 1C
Rocap Number: no data
Heat Number(s): no data
Mfg. Lot Number: 33708-6215287602
Finish Coating: ASTM F2329 - Hot Dip
Product Markings: 2HZN U
Size: 1 in
Gage Type: Pass