Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001218 DEA: 010M9604 EFIS: 0123000106
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101,271-Var
Work Description: POLYESTER CONCRETE OVERLAY, HMA, & COLD PLANE AC PAVEMENT.
Location Description: MENDOCINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: GR Sundberg, INC. Jeff Earhart
Resident Engineer: Lucy Kostrezewa Structure Rep.: Unknown
DIME Sample ID: 2026-04-23-5
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: 04/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/23/2026
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: 10-0204L
Structure name: Moore Street UC
The fabricator/manufacturer/facility name: Kwitbond Polymers
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 01-MEN-101
Direction of Travel: South
Post Mile:
Lanes to be Tested: Lane #1,Lane #2
Station: 30.43
DIME Test ID: 2026-04-23-5-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 05/08/2026
Date Tested: 05/06/2026
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: TRIAL SLAB 101 SB
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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0.40
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DIME Test ID: 2026-04-23-5-2
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 06/23/2026
Date Tested: 06/19/2026
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: Blue Lake UC
Test Result Compliance: complies
Additional Comments When Verified:
|
Pavement or Bridge Deck?
|
Bridge Deck
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|
Average Coefficient of Friction
|
0.40
|
