Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994358 DEA: 033J3304 EFIS: 0322000251
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-12-0/0.5
Work Description: MMBN Project. Replace backup drive system, replace lift span deck, install hydraulic barrier system and new generator, replace electrical control system, install new traffic gates and elevators, traffic control,
Location Description:
Contractor Name: Golden State Bridge, Inc.
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Ephrem Tweldeberham Structure Rep.: Rusty D'Anna
DIME Sample ID: 2026-06-19-20
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 06/19/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/19/2026
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:
Structure name:
The fabricator/manufacturer/facility name: Caltrans METS
Pavement Surface Type: Methacrylate Resin
Type of Traffic Control Provided: Moving Lane Closure
DIST-CO-RTE: 03-SAC-12
Direction of Travel: East
Post Mile:
Lanes to be Tested: Lane #1
Station:
DIME Test ID: 2026-06-19-20-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 06/22/2026
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: RIO VISTA BRIDGE
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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0.39
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