Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994245 DEA: 051H4304 EFIS: 0516000073
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-21.4/21.9
Work Description: San Jose Creek Bridge replacement
Location Description: SANTA BARBARA COUNTY IN GOLETA FROM ROUTE 101/217 SEPARATION TO 0.3 MILE NORTH OF SAN JOSE CREEK BRIDGE
Contractor Name: MCM CONSTRUCTION
Contractor Address: 6413 32nd Street, North Highlands, Ca 95660
Resident Engineer: Manny Yogarajah Structure Rep.: Fabian Velasco
DIME Sample ID: 2025-06-17-5
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Santa Barbara 1
Sample Organization Contact: (805) 441-6932
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 06/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/17/2025
The quantity of what the sample constitutes: 1 bridge shoulder
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 51-0367L
Structure name: Southbound 101 SAN JOSE CREEK BR
The fabricator/manufacturer/facility name: MCM Construction
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 05-SB-101
Direction of Travel: South
Post Mile: 21.50
Lanes to be Tested: Shoulder
Station:
DIME Test ID: 2025-06-17-5-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 07/11/2025
Date Tested: 07/11/2025
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: SAN JOSE CREEK BR/SHOULDER
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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0.37
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