Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000078 DEA: 051P2804 EFIS: 0522000016
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR,-1-17.02/17.02
Work Description: REPLACE SEPARATION BRIDGE GIRDER.
Location Description: SANTA CRUZ COUNTY IN SANTA CRUZ AT ROUTE 1 NORTHBOUND/17 SEPARATION
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Ian Nguyen Structure Rep.: Stephen Pozzo
DIME Sample ID: 2024-12-17-1
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: 12/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/17/2024
The quantity of what the sample constitutes: POLYESTER
A brief description of the sample: POLYESTER
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JOB SITE
DIME Test ID: 2024-12-17-1-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 12/23/2024
Date Tested: 12/23/2024
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: RTE 1NB/17 SEP/BR#36-0069R
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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0.44
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