Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000357 DEA: 07341304 EFIS: 0717000187
QA Service Level: 2
DIST-CO-RTE-PM: 07---
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Francisco J Martinez Structure Rep.: Unknown
DIME Sample ID: 2024-08-15-123
TL Number from the TL Form:
Sample Submitted By Organization: LAC Metro
Sample Organization Contact: (213) 418-3291
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 08/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/23/2024
The quantity of what the sample constitutes: 8 Bolt Assemblies
A brief description of the sample: 1 1/4" x 4 1/2" Heavy Hex Bolt Assemblies
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS
Rocap Number(s):
Heat Number(s): 10631690
Nut Mfg. Lot Number(s): 18876-144429
Washer Mfg. Lot Number(s): D8476
Bolt Specification: ASTM A325
Bolt Length(s):
Nut Specification: ASTM A563
Washer Specification: ASTM F436
Finish:
Diameter/Size: 1 1/4"
Bolt Mfg. Lot Number: M5308
Rocap Test Requirement(s):
Lubricant Requirements(s):
