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: 2020-03-06-9
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 03/06/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 203
A brief description of the sample: 3/4" x 30" Anchor Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AM Nut and Bolt
Rocap Number(s):
Heat Number(s): 3076376
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: tbd
Bolt Length(s): 30"
Nut Specification: tbd
Washer Specification: tbd
Finish:
Diameter/Size: 3/4" x 30"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
