Sample Record for 2021-06-15-5
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214795 DEA: 030H3424 EFIS: 0317000153
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99-22.6
Work Description: REPLACE BRIDGE DECK WITH PRESTRESSED CONCRETE BOX GIRDER.
Location Description: SACRAMENTO COUNTY IN SACRAMENTO AT 21ST AVENUE UNDERCROSSING
Contractor Name: BRIDGEWAY CIVIL CONSTRUCTORS, INC.
Contractor Address: 4950 Allison Parkway, # A, Vacaville, CA 95688
Resident Engineer: Howard Giang Structure Rep.: Brandon Miller
Sample Information
DIME Sample ID: 2021-06-15-5
TL Number from the TL Form: C725807
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Acceptance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 06/15/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 lot
A brief description of the sample: Plain Elastomeric Bearing Pad
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cal-Neva
Material Information
Mfg. Lot Number(s): 12821
Material/Compound/Elastomer ID: NC 8168
Samples Representing: 1 Lot
Description (size): 0.5x8x12
Comments:
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): Warco Biltrite
Batch Number: 1
Test Results
