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: 2023-04-05-9
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: 04/05/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 280 pcs.
A brief description of the sample: 3/4" x 15" anchor bolt
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: A & M Nut & Bolt
Rocap Number(s):
Heat Number(s): 5804978708
Nut Mfg. Lot Number(s): 5805312403
Washer Mfg. Lot Number(s): B64398
Bolt Specification: ASTM F1554
Bolt Length(s): 15"
Nut Specification: ASTM A194
Washer Specification: ASTM F436
Finish: HDG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number:
Rocap Test Requirement(s):
Lubricant Requirements(s):
