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Testing Report for 2019-03-07-3-4

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

Project Information

DEA: 120H1004
EFIS: 1200000180
Project ID: 208973
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405,73,405,605-9.3/24.3
Work Description: (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP.
Location Description: Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Hank Alonso (reports)
Structure Rep.: Cal Zachman (reports)

Sample Information

DIME Sample ID: 2019-03-07-3
TL Number from the TL Form:
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: 3/7/2019
Date that the sample was received by the laboratory/organization performing the testing: 3/8/2019
The quantity of what the sample constitutes: 4
A brief description of the sample: bearing pads
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Scougal Rubber

Material Information

Mfg. Lot Number(s): 17102 1 17102 7 17102 8 17102 9
Material/Compound/Elastomer ID: na
Samples Representing: 168
Description (size): 3.5"x22"x22" through 6"x20"x20"
Comments: Unknown
Description (Number of Shims): 8 through 12
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: na

Test Information

DIME Test ID: 2019-03-07-3-4
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 3/12/2019
Verified Date: 3/12/2019
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