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Testing Report for 2018-04-10-1-5

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

Project Information

DEA: 07290704
EFIS: 0712000076
Project ID: 210828
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-47-0.9/2.0
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Thang Ton
Structure Rep.: Noah Bruton

Sample Information

DIME Sample ID: 2018-04-10-1
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Sacramento Field Laboratory
Sample Organization Contact: (916) 227-7263
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 4/10/2018
Date that the sample was received by the laboratory/organization performing the testing: 4/18/2018
The quantity of what the sample constitutes: 2
A brief description of the sample: A449 Anchor Rods
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CK Johnson INdustries

Material Information

Rocap Number(s):
Heat Number(s): 6214434108
Nut Mfg. Lot Number(s): 26729
Washer Mfg. Lot Number(s): 0817-609
Bolt Specification: A449
Bolt Length(s): 20-1/4" , 18-3/4"
Nut Specification: A563
Washer Specification: F436
Finish: GALV.
Diameter/Size: 1-1/4
Bolt Mfg. Lot Number: 166399
Rocap Test Requirement(s):
Lubricant Requirements(s): Blue dye

Test Information

DIME Test ID: 2018-04-10-1-5
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 4/18/2018
Verified Date: 4/23/2018
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: 26729-6214434108
Finish Coating: ASTM F2329 - Hot Dip
Product Markings: U DH
Size: 1.250 in
Gage Type: Pass