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: 2026-04-15-4
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: 04/15/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/21/2026
The quantity of what the sample constitutes: 2 of 150
A brief description of the sample: 2" X 5' ASTM F1554 Gr.55
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS Lindon UT
Rocap Number(s): None
Heat Number(s): 1201069327
Nut Mfg. Lot Number(s): N/A
Washer Mfg. Lot Number(s): N/A
Bolt Specification: ASTM F1554 Gr.55
Bolt Length(s): 5'
Nut Specification: N/A
Washer Specification: N/A
Finish: galvanize
Diameter/Size: 2" x 5' Anchor Bolt
Bolt Mfg. Lot Number: 1201069327
Rocap Test Requirement(s): NONE
Lubricant Requirements(s): NONE
Washer Inner Diameter(s): None
