Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994816 DEA: 010E11U4 EFIS: 0123000069
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-1-31.1/31.6
Work Description: STRUCTURAL CONC BRIDGE, TEMP BRIDGE AND BAR REINFORCING STEEL.
Location Description: MENDOCINO COUNTY NEAR ELK FROM 0.2 MILE SOUTH OF ELK CREEK BRIDGE TO 0.2 MILE NORTH OF ELK CREEK BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 1324 S. State Street, Ukiah, CA 95482
Resident Engineer: Mojtaba Mosallai Structure Rep.: Mostafa Bayoumi
DIME Sample ID: 2025-09-23-6
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3667 - Redwood Valley/Fort Bragg
Sample Organization Contact: (707) 498-1012
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 09/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/29/2025
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: 23-0123000069
Structure name: Elk Creek Bridge
The fabricator/manufacturer/facility name: geoaggregates
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 01-Men-1
Direction of Travel: South
Post Mile: 31.10
Lanes to be Tested: Shoulder,Lane #1,Lane #2
Station:
DIME Test ID: 2025-09-23-6-5
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 11/12/2025
Date Tested: 11/10/2025
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:
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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0.35
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