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Testing Report for 2018-03-13-10-4

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

Project Information

DEA: 083555V4
EFIS: 0814000086
Project ID: 210569
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-42.5/46.0
Work Description: WIDEN I-15, RECONSTRUCT 3 IC'S, CONSTRUCT 2 NEW BR AND WIDEN 3 BR.
Location Description: SAN BERNARDINO COUNTY IN VICTORVILLE FROM 0.5 MILE NORTH OF MOJAVE DRIVE TO 1.5 MILE NORTH OF STODDARD WELLS ROAD OVERCROSSING
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Taghreed Al-Khateeb
Structure Rep.: Ravinder Singh

Sample Information

DIME Sample ID: 2018-03-13-10
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: 3/13/2018
Date that the sample was received by the laboratory/organization performing the testing: 3/15/2018
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): 16318-1R
Material/Compound/Elastomer ID: Unknown
Samples Representing: 11
Description (size): 5"x15"x15"
Comments: Unknown
Description (Number of Shims): 10
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: Unknown

Test Information

DIME Test ID: 2018-03-13-10-4
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 3/23/2018
Verified Date: 3/26/2018
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