Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000555 DEA: 101T4304 EFIS: 1024000258
QA Service Level: 1
DIST-CO-RTE-PM: 10---
Work Description:
Location Description:
Contractor Name: MYERS AND SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Zubair Anwar Structure Rep.: Unknown
DIME Sample ID: 2024-10-06-3
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 10/06/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/06/2024
The quantity of what the sample constitutes: PCC
A brief description of the sample: PCC
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: BRIDGE
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested:
Station:
DIME Test ID: 2024-10-06-3-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 10/07/2024
Date Tested: 10/06/2024
Submitted By Organization: CT HQ - FFS - Skid Testing
Organization Address: ,
Organization City:
Organization State:
Organization Zipcode:
Organization Email: steven.seifert@dot.ca.gov
Organization Phone: (916) 227-8588
General Comments for this Test: INGRAM CREEK RD UC BR#38-0125L
Test Result Compliance: complies
Additional Comments When Verified:
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Pavement or Bridge Deck?
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Bridge Deck
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Average Coefficient of Friction
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0.36
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