Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001123 DEA: 051H4704 EFIS: 0516000078
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-9-9-13.6,15.5
Work Description: REPLACE BRIDGES AND INSTALL MGS.
Location Description: SANTA CRUZ COUNTY NEAR BOULDER CREEK AT SAN LORENZO RIVER BRIDGE AND AT KINGS CREEK BRIDGE
Contractor Name: GORDON N. BALL, INC.
Contractor Address: Unknown
Resident Engineer: Gareth Gill Structure Rep.: Jarred Burrows
DIME Sample ID: 2026-03-27-34
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: 44
A brief description of the sample: Laminated 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): 2527-2
Material/Compound/Elastomer ID: LEP1
Samples Representing: 44
Description (size): 2.30" x 14" x 14"
Comments:
Description (Number of Shims): 4
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Bridge Rubber Bearing
Batch Number: 155833
