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: 2025-10-21-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 10/21/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/21/2025
The quantity of what the sample constitutes: 2 Samples from 200 ea.
A brief description of the sample: 1 1/4"x 36" HDG Double end Anchor Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo Structural Products
Rocap Number(s):
Heat Number(s): Bolt 20948400
Nut Mfg. Lot Number(s): Nucor lot W000222137 / heat 8000027695
Washer Mfg. Lot Number(s): Prestige Lot 7373/ heat 240419
Bolt Specification: ASTM F1554-55
Bolt Length(s): 36"
Nut Specification: ASTM A563 Grade DH
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 1 1/4"
Bolt Mfg. Lot Number: Charter Steel lot 2272578
Rocap Test Requirement(s):
Lubricant Requirements(s):
Washer Inner Diameter(s):
