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: 2020-10-21-3
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: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 10/21/2020
Date that the sample was received by the laboratory/organization performing the testing: 10/23/2020
The quantity of what the sample constitutes: 48
A brief description of the sample: 2 1/2" x 42" 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
Rocap Number(s):
Heat Number(s): Bolt 3094713
Nut 190483
Washer 209034
Nut Mfg. Lot Number(s): DEBL
Washer Mfg. Lot Number(s): 209034
Bolt Specification: ASTM F1554-15 Gr 55-S1
Bolt Length(s): 42"
Nut Specification: ASTM A563 Gr. DH
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 2 1/2"
Bolt Mfg. Lot Number: 50998-ppo
Rocap Test Requirement(s):
Lubricant Requirements(s):
