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: 2026-02-20-3
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: 02/20/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/25/2026
The quantity of what the sample constitutes: 3 samples from 400 ea.
A brief description of the sample: 3/4"-10 HDG Coupling Nut
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corp.
Rocap Number(s):
Heat Number(s): 100023218440
Nut Mfg. Lot Number(s): R972612
Washer Mfg. Lot Number(s): n/a
Bolt Specification: N/A
Bolt Length(s): n/a
Nut Specification: ASTM A563 Grade DH
Washer Specification: N/A
Finish: Hot Dip Galvanize
Diameter/Size: 3/4" x 2 1/4"
Bolt Mfg. Lot Number: n/a
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
