Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993662 DEA: 061A6404 EFIS: 0620000176
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41,180-R23.1,R58.7
Work Description: PLACE POLYESTER CONCRETE OVERLAY AND REPLACE JOINT SEAL ASSEMBLY.
Location Description: FRESNO COUNTY IN FRESNO ON ROUTE 41 AT VENTURA AVENUE VIADUCT AND ON ROUTE 180 AT ROUTE 180/41 CONNECTOR SEPARATION
Contractor Name: TPA CONSTRUCTION INC.
Contractor Address: 2406 Clubhouse Dr., Rocklin, CA 95765
Resident Engineer: Fernando De Alba Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2023-09-05-6
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: TEST SLAB
A brief description of the sample: TEST SLAB
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JOB SITE
DIME Test ID: 2023-09-05-6-1
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: VENTURA AVE VIADUCT/BR # 42-0278-TEST PANEL
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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0.48
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