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Testing Report for 2017-08-03-2-3

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

Project Information

DEA: 033C3804
EFIS: 0300000458
Project ID: 211614
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-50-75.4/77.3
Work Description: HOT MIX ASPHALT, ROADWAY EXCAVATION, AND SIGNAL AND LIGHTING
Location Description: EL DORADO COUNTY IN SOUTH LAKE TAHOE FROM NORTH JUNCTION ROUTE 89 TO TROUT CREEK BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Jaret Montplaisir
Structure Rep.: Alfredo Carranza

Sample Information

DIME Sample ID: 2017-08-03-2
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: (510) 385-8178
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 8/3/2017
Date that the sample was received by the laboratory/organization performing the testing: 8/7/2017
The quantity of what the sample constitutes: 3
A brief description of the sample: F1554 Grade 55 HDG Anchor Bolts
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corp

Material Information

Rocap Number(s):
Heat Number(s): 126517
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: F1554 Gr. 55
Bolt Length(s): 18"
Nut Specification: N/A
Washer Specification: N/A
Finish: HDG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2017-08-03-2-3
Test Method: ASME B1.2-83r01: (Ring Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Ring Gage)
Date Tested: 8/8/2017
Verified Date: 8/9/2017
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.: 1A
Rocap Number: no data
Heat Number(s): 126517
Mfg. Lot Number: no data
Finish Coating: ASTM F2329 - Hot Dip
Product Markings: YELLOW PAINT
Size: .75 in
Bolt Length: 18 in
Gage Type: Pass