Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-07-27-11
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Acceptance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 07/27/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: lot 1
A brief description of the sample: Plain Bearing Pad
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Watson Bowman
Mfg. Lot Number(s): asdf
Material/Compound/Elastomer ID: asdf
Samples Representing: 1 Lot
Description (size): 12 by 13 inc
Comments:
Description (Number of Shims): 2 shims
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): asdf
Batch Number: asdf
