Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214627 DEA: 05344904 EFIS: 0500000505
QA Service Level: 1
DIST-CO-RTE-PM: 05-SBT-156-3/R8.2
Work Description: SAN BENITO ROUTE 156 IMPROVEMENT PROJECT SAN BENITO RTE 156 IMPROVEMENT PROJECT; INCLUDES NEW BRIDGE AND WIDENING OF EXISTING BRIDGE.
Location Description: SAN BENITO COUNTY IN AND NEAR SAN JUAN BAUTISTA FROM THE ALAMEDA TO 0.2 MILE EAST OF FOURTH STREET/BUSINESS ROUTE 156
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 223 Harrison Road 1B, Salinas, CA 93907
Resident Engineer: Frank (Farrukh) Sana Structure Rep.: Neil Weller
DIME Sample ID: 2024-12-02-1
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: 12/02/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/02/2024
The quantity of what the sample constitutes: pcc
A brief description of the sample: BRIDGE
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JOB SITE
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Moving Lane Closure
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested:
Station:
DIME Test ID: 2024-12-02-1-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 12/05/2024
Date Tested: 12/05/2024
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: San Juan Bridge/TRIAL SLAB
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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0.47
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