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Testing Report for 2020-11-09-20-2

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

Project Information

DEA: 07325704
EFIS: 0716000089
Project ID: 213741
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-1.7
Work Description: BUILDING CONSTRUCTION IN LOS ANGELES COUNTY IN SANTA FE SPRINGS AT 14044 FREEWAY DRIVE.
Location Description: Santa Fe Springs, At 14044 Freeway Drive.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Mashhur Ali
Structure Rep.: Nelson Parada

Sample Information

DIME Sample ID: 2020-11-09-20
TL Number from the TL Form:
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: 11/9/2020
Date that the sample was received by the laboratory/organization performing the testing: 11/13/2020
The quantity of what the sample constitutes: 4
A brief description of the sample: A563 Nut & Washer
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sputhwest Bolt Decker

Material Information

Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s): 13-42-001
Washer Mfg. Lot Number(s): 8-175-1
Bolt Specification: None
Bolt Length(s):
Nut Specification: A563
Washer Specification: F436
Finish: Plain
Diameter/Size: .625
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):

Test Information

DIME Test ID: 2020-11-09-20-2
Test Method: ASME B1.2-83r01: (Plug Gage) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Plug Gage)
Date Tested: 12/3/2020
Verified Date: 12/9/2020
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: 13-42-001
Finish Coating: Plain
Product Markings: D
Size: .625 in
Gage Type: Pass