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Sample Record for 2017-05-09-2

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 212117 DEA: 044K4304 EFIS: 0417000309 QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-128-1.3
Work Description: IN SONOMA COUNTY, ON ROUTE 128, EAST OF CLOVERDALE. REPAIR SLIPOUT BY CONSTRUCTING SOLDIER PILE TIE-BACK WALL
Location Description:
Contractor Name: Valentine Corp.
Contractor Address: 111 Pelican Way, San Rafael, CA 94901
Resident Engineer: Scott Hislop Structure Rep.: Jonathan Chi

Sample Information

DIME Sample ID: 2017-05-09-2
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Sacramento Field Laboratory
Sample Organization Contact: (916) 227-7263
Type of Sample: Acceptance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 05/09/2017
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 16
A brief description of the sample: 1.15x8x12 elastomeric bearing
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Scougal Rubber

Material Information

Mfg. Lot Number(s): 15768-1
Material/Compound/Elastomer ID: CP2527VCP2628ARS
Samples Representing: 16 pads
Description (size): 1.15x8x12
Comments:
Description (Number of Shims): 2
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: 0

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.