Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001088 DEA: 040Q1204 EFIS: 0418000045
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-280-7.5/7.5
Work Description: Polyester Concrete Overlay, RHMA Paving, CMS, and Pedestrian Over-crossing project in San Francisco
Location Description: Route 280
Contractor Name: Bay Cities Grading and Paving
Contractor Address: Unknown
Resident Engineer: Charles Koos Structure Rep.: Stanley Ku
DIME Sample ID: 2026-10-08-43
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: 10/08/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/15/2026
The quantity of what the sample constitutes: 44
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): 28350-2
Material/Compound/Elastomer ID: NA
Samples Representing: 44
Description (size): 1" x 8" x 12"
Comments:
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): Scougal Rubber
Batch Number: NA
