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: 2026-03-27-46
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (213) 505-4213
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 03/27/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/16/2026
The quantity of what the sample constitutes: 855
A brief description of the sample: A325 heavy Hex Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fontana Fasteners Ameron International
Rocap Number(s): NA
Heat Number(s): 10976040 190158328 21020160
Nut Mfg. Lot Number(s): 26-57-001
Washer Mfg. Lot Number(s): 1125-84
Bolt Specification: A325
Bolt Length(s): 5-1/2"
Nut Specification: A563
Washer Specification: F436
Finish: HDG
Diameter/Size: 1"
Bolt Mfg. Lot Number: E797X1
Rocap Test Requirement(s): NA
Lubricant Requirements(s): NA
Washer Inner Diameter(s): NA
