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Testing Report for 2017-09-19-7-5

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

Project Information

DEA: 034F4404
EFIS: 0314000163
Project ID: 211824
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,ED,NEV,PLA,SOL,YOL-VAR-VAR
Work Description: UPGRADE CHANGEABLE MESSAGE SIGN TO ADVANCED VARIABLE MESSAGE SIGN
Location Description: SACRAMENTO, EL DORADO, NEVADA, PLACER, SOLANO, AND YOLO COUNTIES AT VARIOUS LOCATIONS
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Randy Stellhorn
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2017-09-19-7
TL Number from the TL Form: NA
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: 9/19/2017
Date that the sample was received by the laboratory/organization performing the testing: 9/22/2017
The quantity of what the sample constitutes: 1
A brief description of the sample: Anchor Rod
From where was the sample collected: Distributor
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: EDSCO

Material Information

Rocap Number(s):
Heat Number(s): 3068917
Nut Mfg. Lot Number(s): W2257/HDG, DCRO/Plain
Washer Mfg. Lot Number(s): 283367
Bolt Specification: F1554 Gr 55
Bolt Length(s): 3'-9"
Nut Specification: A194/HDG, A194 2H/Plain
Washer Specification: F436
Finish: HDG/Plain
Diameter/Size: 2.25
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2017-09-19-7-5
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 9/26/2017
Verified Date: 9/27/2017
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.: 2A
Rocap Number: no data
Heat Number(s): no data
Mfg. Lot Number: DCRO
Finish Coating: Plain
Product Markings: 2HDH D/N
Size: 2.25 in
Gage Type: Pass