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: 2020-11-18-10
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: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 11/18/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 240
A brief description of the sample: ASTM F1554-15 Gr. 55 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):
Nut Mfg. Lot Number(s): 6215177505
Washer Mfg. Lot Number(s): 191080 / 104860
Bolt Specification: ASTM F1554 Grade 55
Bolt Length(s): 12"
Nut Specification: ASTM A563 DH
Washer Specification: ASTM F436
Finish: hot dipped galvanized
Diameter/Size: 5/8"
Bolt Mfg. Lot Number: 3093311
Rocap Test Requirement(s):
Lubricant Requirements(s):
