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Testing Report for 2018-06-12-9-8

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

Project Information

DEA: 07121844
EFIS: 0700000117
Project ID: 3807
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-42.8/47.3
Work Description: CONSTRUCT HOV LANES, RETAINING WALLS AND SOUND WALLS.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES, GLENDALE, AND BURBANK FROM ROUTE 5/134 SEPARATION TO MAGNOLIA BOULEVARD OVERCROSSING
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: James Shih
Structure Rep.: Matthew Remo

Sample Information

DIME Sample ID: 2018-06-12-9
TL Number from the TL Form: C940067
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: 6/12/2018
Date that the sample was received by the laboratory/organization performing the testing: 6/19/2018
The quantity of what the sample constitutes: 7
A brief description of the sample: A490 Bolt assy
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: St Louis Screw Bolt

Material Information

Rocap Number(s): TT0102468
Heat Number(s):
Nut Mfg. Lot Number(s): 28043-178004
Washer Mfg. Lot Number(s): 307768
Bolt Specification: A490
Bolt Length(s): 3.5
Nut Specification: A563
Washer Specification: F436
Finish: Plain
Diameter/Size: 1
Bolt Mfg. Lot Number: 041547
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2018-06-12-9-8
Test Method: ASME B1.2-83r01: (Ring Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Ring Gage)
Date Tested: 6/21/2018
Verified Date: 6/22/2018
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: 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: 041547
Finish Coating: Plain
Product Markings: A490 SL USA
Size: 1 in
Bolt Length: 3.5 in
Gage Type: Pass