Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995119 DEA: 034H6004 EFIS: 0319000004
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-49-R8.7/R10.6
Work Description: CONC BARRIER, JPCP, HMA, RDWY EXC, RCP AND LIGHTING.
Location Description: PLACER COUNTY NEAR AUBURN FROM 0.3 MILE SOUTH OF LORENSEN ROAD/FLORENCE LANE TO 0.4 MILE NORTH OF LONE STAR ROAD
Contractor Name: DESILVA GATES CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Jeff Johnson Structure Rep.: Asia Al Maliki
DIME Sample ID: 2025-02-18-1
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: 02/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 02/18/2025
The quantity of what the sample constitutes: 0.302019CY
A brief description of the sample: Portable Skid Test
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 19-0021
Structure name: NORTH FORK DRY CREEK
The fabricator/manufacturer/facility name: Dees Burke
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 3-PLA-49
Direction of Travel: North
Post Mile:
Lanes to be Tested: Lane #1
Station: STA154+68.85
DIME Test ID: 2025-02-18-1-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 03/20/2025
Date Tested: 03/18/2025
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: Contact Asia Maliki @ asia.al.maliki@dot.ca.gov, (530) 414-4897/NORTH FORK DRY CREEK
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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0.43
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