Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002059 DEA: 060S37U4 EFIS: 0624000230
QA Service Level: 1
DIST-CO-RTE-PM: 06-KIN-41-R48.0/R48.3, R0.0/R7.1
Work Description: JPCP, HMA, aggregate base, earthwork and bridge.
Location Description:
Contractor Name: Teichert Construction (Jael Lopez)
Contractor Address: 5771 S. Toyota Place, Fresno, CA 93725
Resident Engineer: Oscar Sherrill Structure Rep.: Martin Garcia
DIME Sample ID: 2026-09-18-33
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: 09/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2026
The quantity of what the sample constitutes: 27
A brief description of the sample: 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): 28106-1
Material/Compound/Elastomer ID: NA
Samples Representing: 27
Description (size): 2.30" x 13" x 13"
Comments:
Description (Number of Shims): 4
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: NA
