Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994751 DEA: 010C5004 EFIS: 0112000292
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-11.3/34.6
Work Description: Project Name: Bridge Rail Replacement - 3 Bridges
Location Description: Hely Creek, Little Larabee Creek and Butte Creek Bridge.
Contractor Name: Mercer-Fraser Company
Contractor Address: 200 Dinsmore Dr, Fortuna, CA 95540
Resident Engineer: Joaquin Rodriguez Structure Rep.: Shantanu Nalawade
DIME Sample ID: 2025-11-04-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 11/04/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/04/2025
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: 04-0102
Structure name: Little Larabe Creek Bridge
The fabricator/manufacturer/facility name: Mercer Fraser - Fortuna
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 01-HUM-36
Direction of Travel: East
Post Mile:
Lanes to be Tested: Lane #1,Lane #2
Station: 25.27
DIME Test ID: 2025-11-04-5-1
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:
|
Pavement or Bridge Deck?
|
Bridge Deck
|
|
Average Coefficient of Friction
|
0.35
|
DIME Test ID: 2025-11-04-5-2
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:
|
Pavement or Bridge Deck?
|
Bridge Deck
|
|
Average Coefficient of Friction
|
0.35
|
