Sample Record

Owner Lab

  • CT QASI - Sacramento Field Laboratory

DIME Sample ID 2017-05-09-4

Project Information

Project IdentifiersProject ID: 211588
DEA: 030F3104
EFIS: 0300000078
DIST-CO-RTE-PM03-ED-49-23.6/24.5
Award Date12/12/2016
Closeout Date01/08/2019
Work DescriptionREPLACE BRIDGE.
Location DescriptionEL DORADO COUNTY NEAR COLOMA FROM 0.1 MILE EAST OF MARSHALL ROAD TO 0.3 MILE EAST OF LOTUS ROAD
QA Service Level1 (Verified on 10/19/2016)

Sample Information

Sample Taken Date05/09/2017 Sample Unique Key4
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 sample3.45x12x12
The quantity of what the sample constitutes7 From where was the sample collectedSource
First name of sampler or witnessed byKevin Last name of sampler or witnessed byMuser
Title of sampler Telephone number of sampler9165170532
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameScpugal Rubber Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormS19-136-17 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeSMTL TM1 - Elastomeric Bearing Pad Mfg. Lot Number(s)15771-1
Material/Compound/Elastomer IDCP2527VCP2628ARS Samples Representing7
Description (size)3.45x12x12 Comments
Description (Number of Shims)6 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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