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: 2022-05-20-28
TL Number from the TL Form:
Sample Submitted By Organization: QFC Inductries
Sample Organization Contact: (469) 646-0379
Type of Sample: Quality Control
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 05/20/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/31/2022
The quantity of what the sample constitutes: 12
A brief description of the sample: Bolt, nut, washer
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: QFC Industries
Rocap Number(s):
Heat Number(s): Nut 8000013480
Washer 10619030
Nut Mfg. Lot Number(s): 465436A
Washer Mfg. Lot Number(s): L578M1
Bolt Specification: A325-1
Bolt Length(s):
Nut Specification: A563DH
Washer Specification: F436
Finish:
Diameter/Size:
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
