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Testing Report for 2021-09-09-6-8

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

Project Information

DEA: 041A6614
EFIS: 0415000291
Project ID: 213099
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-8.4
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Steven Russell
Structure Rep.: Long Ly

Sample Information

DIME Sample ID: 2021-09-09-6
TL Number from the TL Form:
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: 9/9/2021
Date that the sample was received by the laboratory/organization performing the testing: 9/13/2021
The quantity of what the sample constitutes: 84 fastener assemblies
A brief description of the sample: High Strength Fastener Assemblies
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Bolt

Material Information

Rocap Number(s):
Heat Number(s): Bolt - 62151682-04 Nut - 190004 Washer - 11946910
Nut Mfg. Lot Number(s): 30184-190004
Washer Mfg. Lot Number(s): 0120-343
Bolt Specification: A325
Bolt Length(s): 12"
Nut Specification: A194
Washer Specification: F436
Finish: plain
Diameter/Size: 1" diameter
Bolt Mfg. Lot Number: 54128
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2021-09-09-6-8
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 9/15/2021
Verified Date: 9/15/2021
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:
Organization Phone: (916) 227-7253
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified :

Submitted Test Results

Sample No.: 1B
Rocap Number: no data
Heat Number(s): no data
Mfg. Lot Number: 30184-190004
Finish Coating: Plain
Product Markings: 2H U
Size: 1 in
Gage Type: Pass