Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002314 DEA: 112N2084 EFIS: 1123000287
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5-R12.4/R15.2
Work Description: GRIND BRIDGE DECK, SPALL REPAIR, POLYESTER CONCRETE OVERLAY
Location Description: 11-SD-5-R12.4/R15.2
Contractor Name: TRUESDELL CORP OF CALIFORNIA INC
Contractor Address: 1310 W 23RD STREET, TEMPE AZ 85282
Resident Engineer: Alex Balce Structure Rep.: Unknown
DIME Sample ID: 2026-07-13-38
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 07/13/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/13/2026
The quantity of what the sample constitutes: 19,838 SQFT
A brief description of the sample: Polyester Concrete Overlay
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Broadway OC
The fabricator/manufacturer/facility name: Truesdell Corp.
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 11-SD-5
Direction of Travel: West
Post Mile: 15.18
Lanes to be Tested: Lane #1
Station:
DIME Test ID: 2026-07-13-38-1
Test Method: CTM 342C-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 07/27/2026
Date Tested: 07/13/2026
Submitted By Organization: CT D11 - District 11 Materials Laboratory
Organization Address: 4050 Taylor Street,
Organization City: San Diego
Organization State: CA
Organization Zipcode: 92110
Organization Email: benjamin.haney@dot.ca.gov
Organization Phone: (858) 688-1595
General Comments for this Test:
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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