Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000279 DEA: 023H70U4 EFIS: 0223000161
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-299-15.0/25.7
Work Description: RHMA-G, HMA (TYPE A), COLD PLANE AC, & SOLDIER PILE RETAINING WALL.
Location Description: TRINITY COUNTY NEAR DEL LOMA FROM 1.0 MILE EAST OF TRINITY RIVER BRIDGE NO.05-0006 TO 0.1 MILE WEST OF PRAIRIE CREEK ROAD
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Edward Worden Structure Rep.: Mike Sears
DIME Sample ID: 2025-07-02-43
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (213) 505-4213
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 07/02/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/10/2025
The quantity of what the sample constitutes: NA
A brief description of the sample: Bearing Pad
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Dynamic Rubber
Mfg. Lot Number(s): CR55-012-D
Material/Compound/Elastomer ID: NA
Samples Representing: NA
Description (size): 1.15" x 12" x 13"
Comments:
Description (Number of Shims): 2
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Dynamic Rubber
Batch Number: NA
