Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994687 DEA: 051P2304 EFIS: 0522000002
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON,SLO-101-var
Work Description: POLYESTER CONCRETE OVERLAY AND BRIDGE JOINT SEALS.
Location Description: MONTEREY AND SAN LUIS OBISPO COUNTIES AT VARIOUS LOCATIONS.
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA INC.
Contractor Address: Unknown
Resident Engineer: Hassan Iman Structure Rep.: Unknown
DIME Sample ID: 2023-09-28-38
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: 09/28/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/28/2023
The quantity of what the sample constitutes: TRIAL SLAB
A brief description of the sample: POLYESTER
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: 2023-09-28-38-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 10/02/2023
Date Tested: 09/28/2023
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: TRAFFIC WAY UC-TRIAL SLAB
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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