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Sample Record for 2023-09-05-5

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 994549 DEA: 032G5204 EFIS: 0321000235 QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV,PLA,SIE-20,49,80-VAR
Work Description: PLACE POLYESTER CONCRETE OVERLAY AND REPLACE JOINT SEALS.
Location Description: NEVADA, PLACER AND SIERRA COUNTIES AT VARIOUS LOCATIONS
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST LLC
Contractor Address: 2990 Bay Vista Court, Suite D, Benicia, CA 94510
Resident Engineer: Tad Sampson Structure Rep.: Jimmer Ross

Sample Information

DIME Sample ID: 2023-09-05-5
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: 09/05/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/05/2023
The quantity of what the sample constitutes: BRIDGE DECK
A brief description of the sample: BRIDGE DECK
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JOB SITE

Material Information

Pavement Surface Type:
Type of Traffic Control Provided:
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested:
Station:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2023-09-05-5-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 09/07/2023
Date Tested: 09/07/2023
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: BEAR RIVER/BR# 19-0022 NB MIDDLE MEDIAN
Test Result Compliance: complies
Additional Comments When Verified:
Pavement or Bridge Deck? Bridge Deck
Average Coefficient of Friction 0.50

Test 2 of 2

DIME Test ID: 2023-09-05-5-2
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 09/07/2023
Date Tested: 09/07/2023
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: BEAR RIVER/BR # 19-0022 SB MIDDLE MEDIAN
Test Result Compliance: complies
Additional Comments When Verified:
Pavement or Bridge Deck? Bridge Deck
Average Coefficient of Friction 0.50