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Testing Report for 2018-02-20-1-4

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

Project Information

DEA: 080J0704
EFIS: 0800000282
Project ID: 209694
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-215-0.6/1.7
Work Description: (Alternative Delivery) The CMGC project will reconstruct and improve interchange of I-215 and Barton Road in the City of Grand Terrace, CA.
Location Description: Grade separation at Intersection of I-215 and Barton Road near Grand Terrace, CA. ? On I-215 between I-10 and SR-60.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Fereydoon Alipanah
Structure Rep.: Tim Flores

Sample Information

DIME Sample ID: 2018-02-20-1
TL Number from the TL Form: Unknown
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: 2/20/2018
Date that the sample was received by the laboratory/organization performing the testing: 2/21/2018
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): 16313-1
Material/Compound/Elastomer ID: NA
Samples Representing: NA
Description (size): 3"x16"x16"
Comments: Unknown
Description (Number of Shims): 6
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: NA

Test Information

DIME Test ID: 2018-02-20-1-4
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 2/22/2018
Verified Date: 2/22/2018
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