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Testing Report for 2021-03-01-11-4

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

Project Information

DEA: 044G8204
EFIS: 0413000049
Project ID: 213653
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-10.6/10.8
Work Description: REPLACE SAN RAFAEL HARBOR BRIDGE (ABC)
Location Description: MARIN COUTY, IN SAN RAFAEL, FROM ROUTE 101 NORTHBOUND OFF-RAMP TO 2ND STREET
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Dawit Habteselassie
Structure Rep.: Long N Ly

Sample Information

DIME Sample ID: 2021-03-01-11
TL Number from the TL Form:
Sample Submitted By Organization: Caltrans Vallejo Field Laboratory
Sample Organization Contact: (510) 774-6009
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 3/1/2021
Date that the sample was received by the laboratory/organization performing the testing: 3/11/2021
The quantity of what the sample constitutes: 15 assemblies
A brief description of the sample: 1” x 5-1/2” bolt with washer and nut
From where was the sample collected: Fabricator
Laboratory sample identification: AB547AS
Structure unique identifier:
Structure name: Temporary Modular Bridge
The fabricator/manufacturer/facility name: Acrow Bridge

Material Information

Rocap Number(s): TBD
Heat Number(s): TBD
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: ASTM F3125 Grade A325
Bolt Length(s): 5-1/2”
Nut Specification: ASTM A563 Grade DH
Washer Specification: ASTM F436
Finish: HDG ASTM A153
Diameter/Size: 1"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2021-03-01-11-4
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 3/17/2021
Verified Date: 3/25/2021
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): no data
Mfg. Lot Number: AB547AS
Finish Coating: ASTM F2329 - Hot Dip
Product Markings: no data
Size: 1 in
Gage Type: Pass