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Testing Report for 2019-01-02-1-1

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

Project Information

DEA: No Project
EFIS:
Project ID: 0
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2019-01-02-1
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Bay Area Field Laboratory
Sample Organization Contact: (707) 649-5453
Type of Sample: Quality Assurance
Type of Material: SMTL TM1 - Elastomeric Bearing Pad
Sample Taken Date: 1/2/2019
Date that the sample was received by the laboratory/organization performing the testing: 1/8/2019
The quantity of what the sample constitutes: 1 Lot, A, B C & D production dates
A brief description of the sample: 1/2" Bearing pad Neoprene
From where was the sample collected: Distributor
Laboratory sample identification: Production Code 41-1200-12
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GRT Rubber TEchnologies

Material Information

Mfg. Lot Number(s): A B C D
Material/Compound/Elastomer ID: Neporene
Samples Representing: 4 production dates
Description (size): .5
Comments: Sampled from Lot C
Description (Number of Shims): 0
Type of Bearing Pad: Plain
Description (Thickness of Shims): NA
Manufacturer(s): GRT
Batch Number: BP054012

Test Information

DIME Test ID: 2019-01-02-1-1
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 1/8/2019
Verified Date: 1/8/2019
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