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Sample Record for 2019-12-11-24

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

Project Information

Project ID: 212794 DEA: 024F7804 EFIS: 0213000032 QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA,LAS,PLU,SHA,SIS,TRI-5-22087-25.7
Work Description: CMS SIGNS IN SHASTA COUNTY
Location Description: IN BUTTE, LASSEN, PLUMAS, SHASTA, SISKIYOU AND TRINITY COUNTIES IN VARIOUS LOCATIONS.
Contractor Name: Tullis Inc
Contractor Address: 16951 Clear Creek Road, Redding, CA 96001
Resident Engineer: Joel Gasik Structure Rep.: Nicholas McLean

Sample Information

DIME Sample ID: 2019-12-11-24
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 12/11/2019
Date that the sample was received by the laboratory/organization performing the testing: 12/18/2019
The quantity of what the sample constitutes: 290
A brief description of the sample: 3/4" REG L/W 1060 MG CL55 lock washer
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Structural and Steel Products

Material Information

Rocap Number(s):
Heat Number(s): 1052700
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s): 316401
Bolt Specification: n/a
Bolt Length(s): 2"
Nut Specification: n/a
Washer Specification: ASME B18.21.1
Finish: Mechanically Galvanized to ASTM B695
Diameter/Size: 3/4"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s): not required

Test Results

Test 1 of 3

DIME Test ID: 2019-12-11-24-1
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 12/23/2019
Date Tested: 12/19/2019
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1A
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 316401
Finish Coating ASTM B695 - Mech Galv
Product Markings no data
Size .75 in
Bolt Length no data in
Measurement Average 3.67 mils

Test 2 of 3

DIME Test ID: 2019-12-11-24-2
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 12/23/2019
Date Tested: 12/19/2019
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1B
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 316401
Finish Coating ASTM B695 - Mech Galv
Product Markings no data
Size .75 in
Bolt Length no data in
Measurement Average 4.09 mils

Test 3 of 3

DIME Test ID: 2019-12-11-24-3
Test Method: ASTM B499-14: Standard Test Method for Measurement of Coating Thicknesses by the Magnetic Method: Nonmagnetic Coatings on Magnetic Basis Metals (Coating)
Verified Date: 12/23/2019
Date Tested: 12/19/2019
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Sample No. 1C
Rocap Number no data
Heat Number(s) no data
Mfg. Lot Number 316401
Finish Coating ASTM B695 - Mech Galv
Product Markings no data
Size .75 in
Bolt Length no data in
Measurement Average 3.52 mils