Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212900 DEA: 051G6804 EFIS: 0515000063
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-101-16.2-20.3
Work Description: US 101 PISMO CONGESTION RELIEF PROJECT
Location Description: IN SAN LUIS OBISPO COUNTY IN PSMO BEACH FROM PISMO OVERHEAD TO 0.5 MILE NORTH OF SHELL BEACH ROAD UC
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 351 North Blosser Road, Santa Maria, CA 93458
Resident Engineer: Philip Gaston Structure Rep.: Sal Heredia
DIME Sample ID: 2026-08-03-41
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: 08/10/2026
The quantity of what the sample constitutes: 159
A brief description of the sample: Plain Bearing Pad
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Scougal Rubber
Mfg. Lot Number(s): 27818-1
Material/Compound/Elastomer ID: NA
Samples Representing: 159
Description (size): 1" x 4" x 6"
Comments:
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): Scougal Rubber
Batch Number: NA
