Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-04-03-14
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 04/03/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 500
A brief description of the sample: 5/8" x 3" Rocap Assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales
Rocap Number(s):
Heat Number(s): 20411210
5805804303
149479
Nut Mfg. Lot Number(s): 39361-5805804303
Washer Mfg. Lot Number(s): 149479
Bolt Specification: ASTM F3125 Grade A325
Bolt Length(s): 3"
Nut Specification: ASTM A563 Grade DH
Washer Specification: ASTM F436
Finish: ASTM B696 Class 55
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: BM0338
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
