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: 2023-10-02-11
TL Number from the TL Form:
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: 10/02/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/02/2023
The quantity of what the sample constitutes: 14
A brief description of the sample: A325 ROCAP ASSEMBLY
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Industrial Sales Inc
Rocap Number(s): TT0170864
Heat Number(s): 10825710, 20778810,31906740
Nut Mfg. Lot Number(s): 37068-20778810
Washer Mfg. Lot Number(s): D7506
Bolt Specification: A325
Bolt Length(s): 4"
Nut Specification: A563-DH
Washer Specification: F436
Finish: MG
Diameter/Size: 3/4"
Bolt Mfg. Lot Number: M616
Rocap Test Requirement(s):
Lubricant Requirements(s): Wax dye
