Sample Record for 2026-08-25-6

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: 2026-08-25-6

TL Number from the TL Form:

Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office

Sample Organization Contact: (916) 2058871

Type of Sample: Quality Assurance

Type of Material: SMTL TM3 - Fastener Assembly

Sample Taken Date: 08/25/2026

Date that the sample was received by the laboratory/organization performing the testing: 09/03/2026

The quantity of what the sample constitutes: 41

A brief description of the sample: 1-1/4" x 4-1/2" Heavy Hex Bolt

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Universal Industrial Sales

Rocap Number(s): n/a

Heat Number(s): 79022238

Nut Mfg. Lot Number(s): n/a

Washer Mfg. Lot Number(s): n/a

Bolt Specification: F1554 Gr. 55

Bolt Length(s): 4-1/2"

Nut Specification: n/a

Washer Specification: n/a

Finish: HDG

Diameter/Size: 1-1/4"

Bolt Mfg. Lot Number: 67900

Rocap Test Requirement(s): 0

Lubricant Requirements(s): 0

Washer Inner Diameter(s): 0