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Testing Report for 2021-08-16-4-8

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

Project Information

DEA: 030H4804
EFIS: 0315000198
Project ID: 214175
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99-0.1/1.6,11.8/21.6
Work Description: COLD PLANE AC PAVEMENT AND RHMA OVERLAY.
Location Description: SACRAMENTO COUNTY IN AND NEAR GALT FROM DRY CREEK BRIDGE TO SIMMERHORN ROAD AND IN ELK GROVE AND SACRAMENTO FROM 0.9 MILE SOUTH OF ELK GROVE BOULEVARD TO MARTIN LUTHER KING JR BOULEVARD
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Sushma Lee
Structure Rep.: Kim Noonan

Sample Information

DIME Sample ID: 2021-08-16-4
TL Number from the TL Form: na
Sample Submitted By Organization: CT QASI - Bay Area Field Laboratory
Sample Organization Contact: (707) 649-5453
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 8/16/2021
Date that the sample was received by the laboratory/organization performing the testing: 8/20/2021
The quantity of what the sample constitutes: 500
A brief description of the sample: 1 1/4" x 4" A325 Rocap Assy.
From where was the sample collected: Fabricator
Laboratory sample identification: na
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales Inc

Material Information

Rocap Number(s): TT01443189
Heat Number(s): 100201759, 75069902, B54671
Nut Mfg. Lot Number(s): 804498
Washer Mfg. Lot Number(s): D8476
Bolt Specification: A325
Bolt Length(s): 3"
Nut Specification: A563-DH
Washer Specification: F436
Finish: Mechanical Galvanize
Diameter/Size: 1 1/4"
Bolt Mfg. Lot Number: BM1003
Rocap Test Requirement(s): na
Lubricant Requirements(s): Wax and Dye

Test Information

DIME Test ID: 2021-08-16-4-8
Test Method: ASME B1.2-83r01: (Ring Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Ring Gage)
Date Tested: 8/27/2021
Verified Date: 8/31/2021
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.: 1D
Rocap Number: no data
Heat Number(s): no data
Mfg. Lot Number: BM1003
Finish Coating: ASTM B695 - Mech Galv
Product Markings: A325 USA SL
Size: 1.25 in
Bolt Length: 4 in
Gage Type: Pass