Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000870 DEA: 07369704 EFIS: 0720000023
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-118-12/13.4
Work Description: CONSTRUCT SOLDIER PILE WALLS, SLOPE PROTECTION, AND DRAINAGE SYSTEMS.
Location Description: VENTURA COUNTY IN SOMIS FROM SAND CANYON ROAD TO 0.1 MILE EAST OF BALCOM CANYON ROAD
Contractor Name: C. A. RASMUSSEN, INC.
Contractor Address: Unknown
Resident Engineer: Eloy Castillo Structure Rep.: Azizollah Maghsoudloo
DIME Sample ID: 2026-08-03-31
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: 08/03/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/06/2026
The quantity of what the sample constitutes: NA
A brief description of the sample: 12" x 8" x 1" Bearing Pad
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bridge Rubber Bearing
Mfg. Lot Number(s): 2527-4
Material/Compound/Elastomer ID: NA
Samples Representing: NA
Description (size): 12" x 8" x 1"
Comments:
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): Bridge Rubber Bearing
Batch Number: BRB-1195
