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: 2026-01-22-22
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: 01/22/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/04/2026
The quantity of what the sample constitutes: 250
A brief description of the sample: 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. Inc.
Rocap Number(s): TT0197301
Heat Number(s): 10919900, 5806275503, 190H016595
Nut Mfg. Lot Number(s): 41337-S-5806275503
Washer Mfg. Lot Number(s): 46554- 190H01695
Bolt Specification: A325
Bolt Length(s): 2-3/4"
Nut Specification: A563-DH
Washer Specification: F436
Finish: MG
Diameter/Size: 7/8"
Bolt Mfg. Lot Number: bm1530
Rocap Test Requirement(s): na
Lubricant Requirements(s): Wax and Dye
Washer Inner Diameter(s):
DIME Test ID: 2026-01-22-22-1
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
DIME Test ID: 2026-01-22-22-2
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
