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: 2025-05-22-16
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 05/22/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 32
A brief description of the sample: 1-1/2" x 5.5" A325
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales
Rocap Number(s): FRC09070
Heat Number(s): 20979140, 245191, 236018
Nut Mfg. Lot Number(s): 40262-245191
Washer Mfg. Lot Number(s): 38533-236018
Bolt Specification: A325
Bolt Length(s): 5"
Nut Specification: A563
Washer Specification: F436
Finish:
Diameter/Size: 1.5"
Bolt Mfg. Lot Number: 64975
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
