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Testing Report for 2020-11-18-28-1

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 214114 DEA: 040A5394 EFIS: 0418000244 QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80,12-11.4/12.8, 2.1/2.8
Work Description: Widen EB SR-12 Connector, Construct 3 ramps & 2 box girder bridges, remove existing bridge, etc.
Location Description: I-80/I-680/Route 12 Interchange
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Fernando Dos Santos Structure Rep.: Alejandro Lara

Sample Information

DIME Sample ID: 2020-11-18-28
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (916) 227-7253
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 11/18/2020
Date that the sample was received by the laboratory/organization performing the testing: 11/30/2020
The quantity of what the sample constitutes: 2
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: Dynamic Rubber

Material Information

Mfg. Lot Number(s): CR55-027-20
Material/Compound/Elastomer ID: na
Samples Representing: 92
Description (size): 1"x4"x6"
Comments:
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): Dynamic Rubber
Batch Number: na

Test Information

DIME Test ID: 2020-11-18-28-1
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Verified Date: 12/10/2020
Date Tested: 12/10/2020
Submitted By Organization: CT HQ - Sacramento Chemistry Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: lisa.dobeck@dot.ca.gov
Organization Phone: (916) 227-7919
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified :

Submitted Test Results

Result Pass