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: 2026-03-12-1
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: 03/12/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/18/2026
The quantity of what the sample constitutes: 3 Couplings Nuts
A brief description of the sample: Galvanized Hex Couplings Nuts
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corp
Rocap Number(s): N/A
Heat Number(s): 100013154340
Nut Mfg. Lot Number(s): 26065192
Washer Mfg. Lot Number(s): N/A
Bolt Specification: N/A
Bolt Length(s): N/A
Nut Specification: ASTM A563 Gr. DH
Washer Specification: N/A
Finish: Galvanized
Diameter/Size: 1" X 3"
Bolt Mfg. Lot Number: N/A
Rocap Test Requirement(s): None
Lubricant Requirements(s): None
Washer Inner Diameter(s): None
