Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-12-18-33
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 12/18/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1/4" X 48" 55 DURO BEARING PAD
A brief description of the sample: 1/4" X 48" 55 DURO BEARING PAD
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cal Neva Supply
Mfg. Lot Number(s): LOT# 1390590
Material/Compound/Elastomer ID: LOT 1390590
Samples Representing: CALNEVA
Description (size): 1 FT X 1 FT
Comments:
Description (Number of Shims): NA
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): CALNEVA
Batch Number: LOT 1390590
