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: 2024-09-19-6
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: 09/19/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 of 50
A brief description of the sample: F1554 Grade 55 HDG Anchor Bolts
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Halo Structural Products
Rocap Number(s):
Heat Number(s): 79013999
Nut Mfg. Lot Number(s): W000184115
Washer Mfg. Lot Number(s): 235406
Bolt Specification: ASTM F1554
Bolt Length(s): 13"
Nut Specification: ASTM A563 Gr. DH
Washer Specification: ASTM F436
Finish: ASTM A153
Diameter/Size: 1"
Bolt Mfg. Lot Number: 7901399901 / Ht. #8000029706
Rocap Test Requirement(s):
Lubricant Requirements(s): Green Wax
