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Testing Report for 2016-10-14-2-4

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

Project Information

DEA: 11427404
EFIS: 1116000173
Project ID: 211529
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-94-50.64
Work Description: Replace Campo Creek bridge # 57-0120
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Brandon Farmer
Structure Rep.: Nikki Tiongco

Sample Information

DIME Sample ID: 2016-10-14-2
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: 10/14/2016
Date that the sample was received by the laboratory/organization performing the testing: 10/17/2016
The quantity of what the sample constitutes: 1
A brief description of the sample: Bearing Pad
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Scougal Rubber

Material Information

Mfg. Lot Number(s): 15185-5
Material/Compound/Elastomer ID: NA
Samples Representing: 1
Description (size): 1" x 8" x 12"
Comments: Unknown
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): Scougal Rubber
Batch Number: NA

Test Information

DIME Test ID: 2016-10-14-2-4
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 10/18/2016
Verified Date: 10/18/2016
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