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: 2023-05-25-36
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 05/25/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/30/2023
The quantity of what the sample constitutes: 12
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): 22802-5
Material/Compound/Elastomer ID: NA
Samples Representing: 12
Description (size): 2" x 10" x 10"
Comments:
Description (Number of Shims): 4
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: NA
