Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211690 DEA: 042A3204 EFIS: 0400000817
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-121-9.2/9.4
Work Description: ROADWAY WIDENING, BRIDGE REPLACEMENT, CREEK GRADING
Location Description: NAPA COUNTY IN NAPA AT SILVERADO TRAIL ROAD
Contractor Name: GHILOTTI CONSTRUCTION COMPANY
Contractor Address: 2301 Kerner Blvd Ste. E, San Rafael, CA 94901
Resident Engineer: Fernando Dos Santos Structure Rep.: Chris Moulton
DIME Sample ID: 2017-02-17-2
TL Number from the TL Form: NA
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 02/17/2017
Date that the sample was received by the laboratory/organization performing the testing: 02/22/2017
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: Dynamic Rubber
Mfg. Lot Number(s): CR55-001-17
Material/Compound/Elastomer ID: NA
Samples Representing: 23
Description (size): 2.3" x 8" x 8"
Comments: Unknown
Description (Number of Shims): 4
Type of Bearing Pad: Plain
Description (Thickness of Shims): 14 gage
Manufacturer(s): Dynamic Rubber
Batch Number: NA
DIME Test ID: 2017-02-17-2-1
Test Method: ASTM D4014-03re12: Standard Specification for Plain and Steel-Laminated Elastomeric Bearings for Bridges
Verified Date: 03/01/2017
Date Tested: 03/01/2017
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance: does not comply
Additional Comments When Verified:
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Visual Inspection Compliance
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Does Not Comply
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