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Testing Report for 2017-12-05-2-4

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

Project Information

DEA: 101F1604
EFIS: 1016000107
Project ID: 212143
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-33,5-R16.6
Work Description: BRIDGE REPAIR
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Muhammad Rahman
Structure Rep.: George Samuel

Sample Information

DIME Sample ID: 2017-12-05-2
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: 12/5/2017
Date that the sample was received by the laboratory/organization performing the testing: 12/6/2017
The quantity of what the sample constitutes: 3
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): 16341-1
Material/Compound/Elastomer ID: NA
Samples Representing: 3
Description (size): 2"x 10"x 18"
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: 2017-12-05-2-4
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 12/7/2017
Verified Date: 12/7/2017
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:
Organization Phone: (916) 227-7253
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified :

Submitted Test Results

Result: Pass