Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993779 DEA: 051K7204 EFIS: 0519000001
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-41-3.1
Work Description: CONSTRUCT SOLDIER PILE RETAINING WALL.
Location Description: SAN LUIS OBISPO COUNTY NEAR MORRO BAY AT 3.1 MILES NORTH OF ROUTE 1/41 SEPARATION
Contractor Name: SOUZA CONSTRUCTION
Contractor Address: 4027 Santa Fe Road, San Luis Obispo, CA 93403
Resident Engineer: Matthew Tallone Structure Rep.: Alex Martinez
DIME Sample ID: 2022-08-12-9
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 08/12/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 18 pads
A brief description of the sample: 1"x12"x12" plain neoprene solid pad
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name: retaing wall
The fabricator/manufacturer/facility name: Cal-Neva
Mfg. Lot Number(s): BP065236D
Material/Compound/Elastomer ID: Neoprene Pad 55
Samples Representing: 18 pads
Description (size): 1x12x12
Comments:
Description (Number of Shims): none
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): GRT
Batch Number: BP065236D
