Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 77777 DEA: CHEM-STOCK EFIS: CHEM-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for Chem Lab 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: 2020-02-13-4
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: Retest
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 02/13/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 172
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: A and M Nut and Bolt
Production or Authorization Testing: Retest
Threaded Bar Specification: ASTM A529
Threaded Bar Grade: 55
Threaded Bar Type:
Rebar Size:
Nut Specification for Threaded Bar: N/A
System Manufacturer: Gerau
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: ASTM A153 galvanized
Bar Heat Number(s): 58039813-06
Nut Heat Number(s):
Bar Lot Number: 48601-PPO
Nut Lot Number:
Coupler Heat Number(s):
Coupler Grade:
