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: 2022-08-11-12
TL Number from the TL Form: na
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 08/11/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/11/2022
The quantity of what the sample constitutes: 7
A brief description of the sample: 1" x 4" Rocap assembly
From where was the sample collected: Fabricator
Laboratory sample identification: na
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales Inc
Rocap Number(s): TT0154531
Heat Number(s): 10730510
Nut Mfg. Lot Number(s): 34042-S-201652
Washer Mfg. Lot Number(s): 19392-119493
Bolt Specification: A325
Bolt Length(s): 4"
Nut Specification: A563-DH
Washer Specification: F436
Finish: MG
Diameter/Size: 1"
Bolt Mfg. Lot Number: BM1020
Rocap Test Requirement(s): na
Lubricant Requirements(s): Wax Dye
