Sample Taken Date	01/31/2017	Sample Unique Key	1
Will the laboratory/organization for which you are a member perform testing on this material sample?	Yes	Date that the sample was received by the laboratory/organization performing the testing	02/01/2017
Sample type	Quality Assurance	A brief description of the sample	Plain Bearing Pad
The quantity of what the sample constitutes	Roll	From where was the sample collected	Source
First name of sampler or witnessed by	Pete	Last name of sampler or witnessed by	Etcheverry
Title of sampler	Unknown	Telephone number of sampler	Unknown
Laboratory sample identification	Unknown	Linked DIME Sample ID	Unknown
The fabricator/manufacturer/facility name	Scougal Rubber	Transportation Laboratory (TL) Number	NA
Inspector Lot Number from the Transportation Laboratory (TL) Form	NA	Structure unique identifier	Not set
Structure name	Not set

Material Type	SMTL TM1 - Elastomeric Bearing Pad	Mfg. Lot Number(s)	1607486
Material/Compound/Elastomer ID	NA	Samples Representing	Roll
Description (size)	.25"	Comments	Unknown
Description (Number of Shims)	0	Type of Bearing Pad	Plain
Description (Thickness of Shims)	NA	Manufacturer(s)	SCocougal Rubber
Batch Number	NA

DIME Test ID: 2017-01-31-1-1 ASTM D2240-05re10 (Verified)
DIME Test ID: 2017-01-31-1-2 ASTM D412-06a-re13 (Verified)
DIME Test ID: 2017-01-31-1-3 ASTM D624-00-re12 (Verified)
DIME Test ID: 2017-01-31-1-4 SMTL BILST-06 (Verified)