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Testing Report for 2020-11-17-14-4

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

Project Information

DEA: 050N73U4
EFIS: 0520000166
Project ID: 215129
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-7.3/9.6
Work Description: Segment 4C - Summerland: Construct HOV lanes and rehabilitation. Source inspection of sign structure trusses, lighting structures, steel soldier piles, epoxy coated rebar, headed rebar, welded hoops, column pins.
Location Description: SUMMERLAND FROM 0.2 MILES NORTH OF PARDARO LANE OVERCROSSING TO SAN YSIDRO CREEK BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Tristan Gebhart
Structure Rep.: Bernardo Hernandez

Sample Information

DIME Sample ID: 2020-11-17-14
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: 11/17/2020
Date that the sample was received by the laboratory/organization performing the testing: 11/19/2020
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:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Scougal Rubber

Material Information

Mfg. Lot Number(s): 19213-1
Material/Compound/Elastomer ID: na
Samples Representing: 27
Description (size): 1.5"x12"x12"
Comments:
Description (Number of Shims): 3
Type of Bearing Pad: Steel
Description (Thickness of Shims): 14 gage
Manufacturer(s): Scougal Rubber
Batch Number: na

Test Information

DIME Test ID: 2020-11-17-14-4
Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test
Date Tested: 11/24/2020
Verified Date: 11/24/2020
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:
Additional Comments When Verified :

Submitted Test Results

Result: Pass