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: 2023-03-30-27
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 Control
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 03/30/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 570 pcs
A brief description of the sample: Anchor Bolt assembly F1554 GR55
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corp
Rocap Number(s):
Heat Number(s): 1202047141
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: N/A
Bolt Length(s): 36 inch
Nut Specification: N/A
Washer Specification: N/A
Finish: ASTM A123 Galvanized
Diameter/Size: 1 inch
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
