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Testing Report for 2016-09-28-11-4

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

Project Information

DEA: 010E5704
EFIS: 0114000102
Project ID: 211383
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101,299-VAR
Work Description: BRIDGE REPAIR
Location Description: HUMBOLDT COUNTY AT VARIOUS LOCATIONS
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Mark Gorona
Structure Rep.: Peter O'donnell

Sample Information

DIME Sample ID: 2016-09-28-11
TL Number from the TL Form: NA
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: 9/28/2016
Date that the sample was received by the laboratory/organization performing the testing: 10/3/2016
The quantity of what the sample constitutes: 1
A brief description of the sample: Bearing Pad
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Scougal Rubber

Material Information

Mfg. Lot Number(s): 15196-1
Material/Compound/Elastomer ID: NA
Samples Representing: 7
Description (size): 2.3" x 16" x 20"
Comments: Unknown
Description (Number of Shims): 4
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: NA

Test Information

DIME Test ID: 2016-09-28-11-4
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 10/11/2016
Verified Date: 10/12/2016
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: paul.lukkarila@dot.ca.gov
Organization Phone: (916) 227-7253
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified :

Submitted Test Results

Result: Pass