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: 2026-01-07-8
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: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 01/07/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/07/2026
The quantity of what the sample constitutes: 795
A brief description of the sample: F1554 Hex Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales, Inc.
Rocap Number(s): na
Heat Number(s): 256375
Nut Mfg. Lot Number(s): na
Washer Mfg. Lot Number(s): na
Bolt Specification: F1554 Gr 105
Bolt Length(s): 15"
Nut Specification: na
Washer Specification: na
Finish: HDG
Diameter/Size: 1-1/4""
Bolt Mfg. Lot Number: 60653
Rocap Test Requirement(s):
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
