Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001989 DEA: 07374304 EFIS: 0721000047
QA Service Level: 1
DIST-CO-RTE-PM: 07-UNKNOWN--unknown
Work Description:
Location Description:
Contractor Name: Peterson Chase Construction
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Charles Liu Structure Rep.: Unknown
DIME Sample ID: 2026-06-25-11
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: 06/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/25/2026
The quantity of what the sample constitutes: 1200
A brief description of the sample: A325 Hex Bolt
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): na
Heat Number(s): 10973220
Nut Mfg. Lot Number(s): na
Washer Mfg. Lot Number(s): na
Bolt Specification: A325
Bolt Length(s): 3"
Nut Specification: na
Washer Specification: na
Finish: MG
Diameter/Size: 1/2"
Bolt Mfg. Lot Number: M6344
Rocap Test Requirement(s): na
Lubricant Requirements(s): na
Washer Inner Diameter(s): na
