Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002200 DEA: 061G1904 EFIS: 0623000160
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-58,65,99,178-Var
Work Description: Furnish and place polyester concrete overlay
Location Description: Construction on State Highway in Kern County at various locations.
Contractor Name: J. Francis Company (Diana Hanna)
Contractor Address: Unknown
Resident Engineer: Amarjit Dhaliwal Structure Rep.: Vicente Sanchez
DIME Sample ID: 2026-05-21-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Fresno Construction Field Office
Sample Organization Contact: (559) 243-3828
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 05/21/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/21/2026
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: 50-0205F
Structure name: S65-S99 Connector OC
The fabricator/manufacturer/facility name: J. FRANCIS COMPANY
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 06-Ker-65
Direction of Travel: South
Post Mile: 0.01
Lanes to be Tested: On Ramp
Station: R0.01
DIME Test ID: 2026-05-21-5-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 06/15/2026
Date Tested: 06/04/2026
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
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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0.42
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