Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2019-08-21-2
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: Acceptance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 08/21/2019
Date that the sample was received by the laboratory/organization performing the testing: 08/26/2019
The quantity of what the sample constitutes: 1
A brief description of the sample: 3/4" x 20" F1554 GR55 Hex Bolts
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS Lindon UT
Rocap Number(s): NA
Heat Number(s): 3085621
Nut Mfg. Lot Number(s): NA
Washer Mfg. Lot Number(s): NA
Bolt Specification: ASTM F1554
Bolt Length(s): 20"
Nut Specification: NA
Washer Specification: NA
Finish: Hot Dip Galvanized
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: 56059-1
Rocap Test Requirement(s): NA
Lubricant Requirements(s): NA
