Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215823 DEA: 101H5004 EFIS: 1017000154
QA Service Level: 1
DIST-CO-RTE-PM: 10-CAL-4-15.9/16.3
Work Description: REPLACE BRIDGE
Location Description: CALAVERAS COUNTY NEAR ANGELS CAMP FROM 0.3 MILE WEST OF CHEROKEE CREEK BRIDGE TO 0.1 MILE EAST OF CHEROKEE BRIDGE
Contractor Name: VIKING CONSTRUCTION COMPANY, INC. PM: Will Padilla
Contractor Address: P O BOX 1508, RANCHO CORDOVA, CA 95741
Resident Engineer: Elaine Yip Structure Rep.: Daniel Laureno
DIME Sample ID: 2025-10-02-14
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Concrete Testing Laboratory
Sample Organization Contact: (916) 206-4373
Type of Sample: Informational
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 10/02/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/02/2025
The quantity of what the sample constitutes: smoothness
A brief description of the sample: Bridge Deck Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Viking Construction Company
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE:
Direction of Travel:
Post Mile: 16.20
Lanes to be Tested: Shoulder,Lane #1,Lane #2
Station:
DIME Test ID: 2025-10-02-14-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 10/06/2025
Date Tested: 10/06/2025
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: Testing of a temporary condition for stage construction. Need the information prior to flopping traffic. Please call me. Secondary inspector will be my ASR Johnsky Oveny.Daytime Skid testing.
Test Result Compliance: does not comply
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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0.18
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