DIME - Test Summary

Summary for Test 2019-06-17-11-1

Test performed: SMTL BILST-06

Project Identifiers	Project ID: 213569 DEA: 024F2104 EFIS: 0212000072
DIST-CO-RTE-PM	02-MOD-299-0.5/1.0
Award Date	12/20/2018
Closeout Date	11/15/2021
Work Description	Butte and Ash Creek Bridge Replacement
Location Description	Construction of Butte Creek Bridge and Ash Creek Bridge on Route 299 at Adin
QA Service Level	1 (Verified on 06/26/2019)

Sample Taken Date	06/17/2019	Sample Unique Key	11
Will the laboratory/organization for which you are a member perform testing on this material sample?	Yes	Date that the sample was received by the laboratory/organization performing the testing	06/19/2019
Sample type	Quality Assurance	A brief description of the sample	Bearing Pad
The quantity of what the sample constitutes	2	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Pete	Last name of sampler or witnessed by	Etcheverry
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Scougal Rubber	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	SMTL TM1 - Elastomeric Bearing Pad	Mfg. Lot Number(s)	17865-2
Material/Compound/Elastomer ID	na	Samples Representing	62
Description (size)	2" x 12" x 24"	Comments	Unknown
Description (Number of Shims)	4	Type of Bearing Pad	Steel
Description (Thickness of Shims)	14 gage	Manufacturer(s)	Scougal Rubber
Batch Number	na

DIME Sample ID: 2019-06-17-11

DIME Test ID: 2019-06-17-11-1

Testing Lab: CT HQ - Sacramento Chemistry Laboratory

Test Method: SMTL BILST-06: (Neoprene Verification) Bilstein Test

Test Release Date: 2019-06-21

Input Type: Calculated

Tester's full name: Mariano Pontillas

Date of test: 06/21/2019

Result: Pass

General comments (publicly viewable) (Max 1000 characters):

Test was verified on 6/21/2019 ✔