Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001152 DEA: 07346104 EFIS: 0718000071
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-7.0/7.4
Work Description: RETROFIT BRIDGE, REPLACE BRIDGE RAILINGS, AND CURB RAMPS.
Location Description: LOS ANGELES COUNTY IN LONG BEACH FROM GOLDEN AVENUE TO HARBOR AVENUE
Contractor Name: POWELL CONSTRUCTORS, INC.
Contractor Address: 8555 banana Avenue, Fontana CA 92335
Resident Engineer: Thang Ton Structure Rep.: Saleem Toon
DIME Sample ID: 2026-03-27-33
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: 03/27/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/02/2026
The quantity of what the sample constitutes: 85
A brief description of the sample: 1" x 4" x 6" Plain Elastomeric Bearing Pad
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bridge Rubber Bearing
Mfg. Lot Number(s): 2527-3
Material/Compound/Elastomer ID: PEP1
Samples Representing: 85
Description (size): 1" x 4" x 6"
Comments:
Description (Number of Shims): NA
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): Bridge Rubber Bearing LLC
Batch Number: 155833
