Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 99999 DEA: 0322222
QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Michael Maksimovich Structure Rep.: Unknown
DIME Sample ID: 2024-01-09-12
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 01/09/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 5
A brief description of the sample: ASTM F1554 Gr 55 Anchor Bolt
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corporation
Rocap Number(s):
Heat Number(s): 1202052357
Nut Mfg. Lot Number(s):
Washer Mfg. Lot Number(s):
Bolt Specification: ASTM F1554 Grade 55
Bolt Length(s): 48"
Nut Specification: n/a
Washer Specification: n/a
Finish: HDG
Diameter/Size: 2 1/4"
Bolt Mfg. Lot Number: 120205235721
Rocap Test Requirement(s):
Lubricant Requirements(s):
