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: 2021-06-11-2
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: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 06/11/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 220
A brief description of the sample: anchor bolt assemblies
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: A M Nut and Bolt
Rocap Number(s):
Heat Number(s):
Nut Mfg. Lot Number(s): 33883-5804469504
Washer Mfg. Lot Number(s): D9692
Bolt Specification: ASTM F1544
Bolt Length(s): 12"
Nut Specification: ASTM A194 Heavy Hex Nut, Grade 2H
Washer Specification: ASTM F436
Finish: Hot Dip Galvanized
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: 3093323
Rocap Test Requirement(s):
Lubricant Requirements(s):
