Sample Record for 2026-07-07-11
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
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
Sample Information
DIME Sample ID: 2026-07-07-11
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: 07/07/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/20/2026
The quantity of what the sample constitutes: 4 of 4500
A brief description of the sample: 1" A563 HDG Hex Nut
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: UIS Lindon UT
Material Information
Rocap Number(s): none
Heat Number(s): 5806690802
Nut Mfg. Lot Number(s): N0090-5806690802
Washer Mfg. Lot Number(s): none
Bolt Specification: none
Bolt Length(s): none
Nut Specification: A563
Washer Specification: none
Finish: HDG
Diameter/Size: 1"
Bolt Mfg. Lot Number: none
Rocap Test Requirement(s): none
Lubricant Requirements(s): Blue Dye
Washer Inner Diameter(s): none
Test Results
