Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-11-01-43
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: Stock
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 11/01/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2022
The quantity of what the sample constitutes: 180 lf
A brief description of the sample: 1/2" x 12" x 12" Neoprene bearing pad
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CalNeva
Mfg. Lot Number(s): 205-32-482
Material/Compound/Elastomer ID: 258
Samples Representing: 120 sqft
Description (size): .500 x 12 x 12
Comments:
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): American Biltrite
Batch Number: 205-32-482
