Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000268 DEA: 070W6504 EFIS: 0722000358
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1,90,105,110,405-Var
Work Description: STRUCTURAL CONC, APPROACH SLAB, POLYESTER CONC OVERLAY, & JOINT SEAL.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Steven Zaw Structure Rep.: Bernabe Contreras
DIME Sample ID: 2025-08-29-1
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3670 - Rancho Dominguez
Sample Organization Contact: (714) 616-4012
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 08/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/29/2025
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 53-0741
Structure name: Ventura Blvd UC
The fabricator/manufacturer/facility name: Peterson Chase
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 07-LA-405
Direction of Travel: North
Post Mile: 39.00
Lanes to be Tested: Shoulder,Lane #1,Lane #2,Lane #3,Lane #4,Lane #5
Station:
DIME Test ID: 2025-08-29-1-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 09/18/2025
Date Tested: 09/14/2025
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
General Comments for this Test: Please perform skid test for Polyester Concrete Overlay at 7:00 AM (0700 hours) on Sunday, 9/14/25 on the 405 Freeway Northbound at the Ventura Blvd UC Bridge. This bridge is located on the Northbound 405 Freeway, just South of the 101 Freeway. Polyester
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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0.46
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