Sample Record

Owner Lab

  • CT QASI - Sacramento Field Laboratory

DIME Sample ID 2017-05-09-2

Project Information

Project IdentifiersProject ID: 212117
DEA: 044K4304
EFIS: 0417000309
DIST-CO-RTE-PM04-SON-128-1.3
Award Date02/09/2017
Closeout Date12/20/2017
Work DescriptionIN SONOMA COUNTY, ON ROUTE 128, EAST OF CLOVERDALE. REPAIR SLIPOUT BY CONSTRUCTING SOLDIER PILE TIE-BACK WALL
Location DescriptionNot set
QA Service Level1 (Verified on 03/16/2017)

Sample Information

Sample Taken Date05/09/2017 Sample Unique Key2
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testingNot set
Sample typeAcceptance A brief description of the sample1.15x8x12 elastomeric bearing
The quantity of what the sample constitutes16 From where was the sample collectedSource
First name of sampler or witnessed byKevin Last name of sampler or witnessed byMuser
Title of samplerQA Telephone number of sampler9165170532
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameScougal Rubber Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormS19-135-17 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeSMTL TM1 - Elastomeric Bearing Pad Mfg. Lot Number(s)15768-1
Material/Compound/Elastomer IDCP2527VCP2628ARS Samples Representing16 pads
Description (size)1.15x8x12 Comments
Description (Number of Shims)2 Type of Bearing PadSteel
Description (Thickness of Shims)14 gage Manufacturer(s)Scougal Rubber
Batch Number0

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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