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Testing Report for 2019-10-22-1-6

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

Project Information

DEA: 083555V4
EFIS: 0814000086
Project ID: 210569
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-42.5/46.0
Work Description: WIDEN I-15, RECONSTRUCT 3 IC'S, CONSTRUCT 2 NEW BR AND WIDEN 3 BR.
Location Description: SAN BERNARDINO COUNTY IN VICTORVILLE FROM 0.5 MILE NORTH OF MOJAVE DRIVE TO 1.5 MILE NORTH OF STODDARD WELLS ROAD OVERCROSSING
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Taghreed Al-Khateeb
Structure Rep.: Ravinder Singh

Sample Information

DIME Sample ID: 2019-10-22-1
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 10/22/2019
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2019
The quantity of what the sample constitutes: 8
A brief description of the sample: F3125 Grade F1852 1" x 3-3/4" Fastener
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bristol Machine

Material Information

Rocap Number(s): Set No 31161 20642870
Heat Number(s): 20642870 190609 X1449
Nut Mfg. Lot Number(s): 31335-190609
Washer Mfg. Lot Number(s): D7719
Bolt Specification: ASTM F3125
Bolt Length(s): 3-3/4"
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish: Plain
Diameter/Size: 1"
Bolt Mfg. Lot Number: 31161-20642870
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2019-10-22-1-6
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 10/28/2019
Verified Date: 10/29/2019
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): no data
Mfg. Lot Number: 31335-190609
Finish Coating: Plain
Product Markings: DH U
Size: 1 in
Gage Type: Pass