E_Material Lab Submit Form.pdf
PDF 224 KB Posted
- Attached to
- New Youngs Bay Bridge Deck Testing
- Solicitation number
- S-73000-00013522
- Issued by
- Clatsop County, Oregon
About this file
This document is a Sample Data Sheet from the Oregon Department of Transportation (ODOT) Bridge Preservation Unit for a bridge deck core sampling project on US101: Oregon Coast Highway over New Youngs Bay (contract number BR08306). The form documents the collection of 16 bridge deck core samples, each approximately 4" x 6" in size, with 1 core per bag. The samples are intended for specific laboratory testing, including 4 cores for compression testing and 12 cores for chloride content testing, with detailed instructions for sample preparation and analysis.
The sample collection is part of a larger bridge preservation and engineering assessment, with the samples to be processed by the ODOT Bridge Section - Preservation Engineering located in Salem, Oregon. The documentation is meticulously detailed, including specifications for sample handling such as cutting off the top 1/4" of cores for chloride testing and cutting subsequent sections at 1/2" increments. The form is identified with contract number 22BRAI-021-P51 and includes contact information for Jason Rice, the project contact person, with instructions to use the "Project Name (Section)" field as the "Project Title" on online laboratory reports.
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Other files
| File | Type | Posted |
|---|---|---|
| 00013522_NYB_RFCQ.doc | DOC document | |
| A_BR08306 Coring Plan.pdf | ||
| B_Blank Core Log Form.pdf | ||
| C_Example Core Log.pdf | ||
| D_BR08306 Plan View Sheets.pdf | ||
| RFP 2025-36-Notice of Intent to Award.pdf | ||
| 00013522_NYB_Sample Contract.docx | DOCX document |
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Text version
F - -
COMPLETE THIS SECTION FOR ALL SAMPLES
* CLASS OF SAMPLE
QUALITY CONTROL VERIFICATION THIRD PARTY
SOURCE/PRODUCT COMPLIANCE x OTHER (SPECIFY IN REMARKS)
* Required information. If information is missing, testing will be delayed.
** Additional information required for Asphalt Cement samples.
CREW NUMBER
* MATERIAL (DESCRIPTION, SIZE, GRADE, BRAND)
PROJECT NAME (SECTION)
PROJECT MANAGER
NUMBER OF SAMPLES (BAGS, BOXES, OTHER) QUANTITY REPRESENTED BY SAMPLE
~4" x 6" Bridge Deck Cores
One Data Sheet Per Asphalt Cement Type or Aggregate Size
SIGNATURE
AASHTO T-260 / ASTM C39
US101: Oregon Coast Highway over New Youngs Bay (BR08306)
C0NTRACTOR OR SUPPLIER
STREET ADDRESS
ODOT Bridge Preservation Unit
DATE SHIPPED
DATE SAMPLED
4040 Fairview Industrial Drive SE, MS#4
CREW NUMBER
LABORATORY REPORT NUMBER
SAMPLE DATA SHEET
SAMPLE NUMBER
CONTRACT NUMBER
* USE OF MATERIAL
Salem, OR 97302 503-798-7506
* FIELD TESTED OR SUBMITTED BY (PRINT NAME)
Jason Rice
ODOT Bridge Section - Preservation Engineering
BR08306 Deck See Core Tags
* PHONE NUMBER
COMPANY NAME
* SOURCE OF MATERIAL (MANUFACTURER, SUPPLIER, OR SOURCE NO. & NAME FOR NATURAL MATERIALS) SAMPLED AT (LOCATION OR STATION NUMBERS)
** Lot & Sublot ** Date
* CONTACT PHONE NUMBER
REMARKS / SPECIAL REQUIREMENTS
1 core per bag16
CITY, STATE AND ZIP CODE
ASPHALT CEMENT
Note:
BID ITEM NUMBER
* PROJECT CONTACT PERSON
Jason Rice
22BRAI-021-P51
* CON NO. & EA * DATA SHEET NUMBER
Test 4 cores for compression.
Test 12 cores for chloride content.
For samples for chloride test:
Cut off top 1/4" and discard. Cut sections at 1/2" increments and test as many as can safely be cut.
Please use "Project Name (Section)" field on this form for "Project Title" on online Lab Reports
Jason.J.RICE@odot.oregon.gov
734-4000 (10-2008)
File details come from the government source that posted it. Updated .