Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994675 DEA: 07390204 EFIS: 0722000334
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-47-0.4 / 2.1
Work Description: Bridge deck replacement with lightweight precast deck panels ultra high performance concrete. Also includes: replacement of seismic sensors, upgrades to median barrier, railings, fences and guard rails. New finger joints.
Location Description: RTE 47 between Terminal Island and San Pedro PM 0.4/2.1
Contractor Name: Skanska
Contractor Address: 1995 Agua Mansa Rd, Riverside, CA 92509
Resident Engineer: Sam Gallardo Structure Rep.: Sami Deeb
DIME Sample ID: 2026-03-12-8
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: Concrete
Sample Taken Date: 03/12/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/12/2026
The quantity of what the sample constitutes: 3- 6x12 Concrete cylinders
A brief description of the sample: Concrete Cylinders
From where was the sample collected: Fabricator
Laboratory sample identification: 1088-224EQ
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Coreslab Strcutures
The concrete mix design number: 2556-1-TB
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 2556
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SCC- Light weight concrete
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
