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Testing Report for 2020-10-22-6-1

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

Project Information

DEA: 06470904
EFIS: 0600000973
Project ID: 209520
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-99-R7.5/15.1
Work Description: WIDEN FREEWAY FROM 4 LANES TO 6 LANES.
Location Description: MADERA COUNTY IN AND NEAR MADERA FROM AVENUE 12 OVERCROSSING TO 0.9 MILE NORTH OF AVENUE 17 OVERCROSSING
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Eric Karlson
Structure Rep.: Peter Moua

Sample Information

DIME Sample ID: 2020-10-22-6
TL Number from the TL Form: na
Sample Submitted By Organization: CT QASI - Bay Area Field Laboratory
Sample Organization Contact: (707) 649-5453
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 10/22/2020
Date that the sample was received by the laboratory/organization performing the testing: 10/30/2020
The quantity of what the sample constitutes: 864
A brief description of the sample: Anchor Bolt Hardware
From where was the sample collected: Fabricator
Laboratory sample identification: na
Structure unique identifier:
Structure name: na
The fabricator/manufacturer/facility name: Universal Industrial Sales

Material Information

Rocap Number(s): na
Heat Number(s): 201216
Nut Mfg. Lot Number(s): DEBZ
Washer Mfg. Lot Number(s): na
Bolt Specification: na
Bolt Length(s): na
Nut Specification: A563-DH/A153/F2329
Washer Specification: na
Finish: HDG
Diameter/Size: 2-1/4"
Bolt Mfg. Lot Number: na
Rocap Test Requirement(s): na
Lubricant Requirements(s): na

Test Information

DIME Test ID: 2020-10-22-6-1
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 11/3/2020
Verified Date: 11/4/2020
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: DEBZ
Finish Coating: ASTM F2329 - Hot Dip
Product Markings: DH D/N 2H
Size: 2.25 in
Gage Type: Pass