Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001172 DEA: 033G2304 EFIS: 0323000248
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-50,99-Var
Work Description: FURNISH AND PLACE POLYESTER CONCRETE OVERLAY.
Location Description: SACRAMENTO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Luis Pompa Structure Rep.: Vian Ghazi
DIME Sample ID: 2025-09-16-10
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 09/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/16/2025
The quantity of what the sample constitutes: Trial Slab and 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: 24-0027
Structure name: North Lagoon Creek
The fabricator/manufacturer/facility name: Myers and Sons Construction
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 03-SAC-99
Direction of Travel: North
Post Mile: 5.06
Lanes to be Tested: Shoulder,Lane #1,Lane #2
Station:
DIME Test ID: 2025-09-16-10-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 09/25/2025
Date Tested: 09/25/2025
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: SIMMERHORN RD BRIDGE #240138
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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0.41
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