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Testing Report for 2017-04-24-2-10

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

Project Information

DEA: 010B27U4
EFIS: 0115000111
Project ID: 211223
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-14.9/15.3
Work Description: CONSTRUCT RETAINING WALLS AND RECONSTRUCT ROADWAY
Location Description: DEL NORTE COUNTY ABOUT 10 MILES NORTH OF KLAMATH FROM 2.2 MILES TO 2.6 MILES NORTH OF WILSON CREEK BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Karen Sanders
Structure Rep.: Brian Cinkutis

Sample Information

DIME Sample ID: 2017-04-24-2
TL Number from the TL Form: C944451
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (916) 227-7253
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 4/24/2017
Date that the sample was received by the laboratory/organization performing the testing: 5/11/2017
The quantity of what the sample constitutes: 12
A brief description of the sample: F1554 Grade 105 HDG Anchor Bolts
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Gaffney Bolt Compant

Material Information

Rocap Number(s):
Heat Number(s): 62140458-03
Nut Mfg. Lot Number(s): 308034A
Washer Mfg. Lot Number(s): 0812-881
Bolt Specification: F1554-105 HDG
Bolt Length(s): 24"
Nut Specification: A563
Washer Specification: F436
Finish: HDG
Diameter/Size: 0.875
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2017-04-24-2-10
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 5/15/2017
Verified Date: 5/15/2017
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.: 1B
Rocap Number: no data
Heat Number(s): no data
Mfg. Lot Number: 308034A
Finish Coating: ASTM F2329 - Hot Dip
Product Markings: DH N
Size: no data
Gage Type: Pass