Sample Record for 2026-06-19-33
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001640 DEA: 010N2904 EFIS: 0123000202
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-197,199-Var
Work Description: REPLACE BRIDGE, EXCAVATION, AND RETAINING WALLS.
Location Description: DEL NORTE COUNTY AT VARIOUS LOCATIONS
Contractor Name: McCullough Construction, Inc.
Contractor Address: 57 Aldergrove Rd, Arcata, CA 95521
Resident Engineer: Aaron Valley Structure Rep.: Joshua Lee
Sample Information
DIME Sample ID: 2026-06-19-33
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: 06/19/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/26/2026
The quantity of what the sample constitutes: 14
A brief description of the sample: Versiflex Elastomeric Pad
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DS Brown
Material Information
Mfg. Lot Number(s): 1090477-1102-2SA
Material/Compound/Elastomer ID: 1090477 1102 2SA
Samples Representing: 14
Description (size): 18.5" x 15.75" x 1"
Comments:
Description (Number of Shims): NA
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): DS Brown
Batch Number: 1090477-1102-2SA
Test Results
