Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993730 DEA: 010K7704 EFIS: 0121000008
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101,162-14.6,15.9,0.7
Work Description: Repair 3 Bridges
Location Description: MENDOCINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Katharine Perrin Structure Rep.: Kitt Tongthaworn
DIME Sample ID: 2023-02-06-14
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Department Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 02/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/06/2023
The quantity of what the sample constitutes: NA
A brief description of the sample: Bridge deck surface
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
DIME Test ID: 2023-02-06-14-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 02/27/2023
Date Tested: 02/07/2023
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:
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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0.36
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