Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001375 DEA: 040A53T4 EFIS: 0421000155 COOP: 040A53TCM
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80-L1.8/L3.2
Work Description: Construct I-80 WB Truck Scales
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SOLANO COUNTY IN AND NEAR FAIRFIELD ON ROUTE 12 FROM THE 80/12 EAST JUNCTION TO 0.9 MILE EAST OF CHADBOURNE ROAD UNDERCROSSING AND ON ROUTE 80 FROM 0.5 MILE WEST OF DAN WILSON CREEK BRIDGE TO WEST TEXAS STREET UNDERCROSSI
Contractor Name: Kiewit Infrastructure West Co.
Contractor Address: 4650 Business Center Drive, Fairfield, CA 94534
Resident Engineer: Darren Isada Structure Rep.: Nana Budu
DIME Sample ID: 2025-12-16-27
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 12/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/22/2025
The quantity of what the sample constitutes: 7
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: Scougal Rubber
Mfg. Lot Number(s): 26797-1
Material/Compound/Elastomer ID: NA
Samples Representing: 7
Description (size): 2.3" x 16" x 26"
Comments:
Description (Number of Shims): 4
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: NA
