Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000204 DEA: 032G8004 EFIS: 0322000164
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV,PLA-80-Var
Work Description: REMOVE, FURNISH, & PLACE POLYESTER CONCRETE OVERLAY.
Location Description: NEVADA AND PLACER COUNTIES AT VARIOUS LOCATIONS
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: 3269 Swetzer Road, Loomis, CA 95650
Resident Engineer: Martin Clark Structure Rep.: zachary chao
DIME Sample ID: 2024-10-22-60
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Quality Assurance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 10/22/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/22/2024
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Portable Skid Test
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Towele OH
The fabricator/manufacturer/facility name: Job Site
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 03-Pla-80
Direction of Travel: East
Post Mile: 45.71
Lanes to be Tested: Lane #2
Station:
DIME Test ID: 2024-10-22-60-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 10/27/2024
Date Tested: 10/22/2024
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:
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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0.38
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