Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994785 DEA: 023H32U4 EFIS: 0221000164
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-I5-2.5/R15.9
Work Description: Roadway rehabilitation and bridge improvements along I5 in Mount Shasta
Location Description: SIS I5 2.5/R15.9
Contractor Name: Gordon Stout - Walsh/Myers
Contractor Address: 1390 Willow Pass Rd Suite 950, Concord, CA 94520
Resident Engineer: Austin Henry Structure Rep.: Mike Sears
DIME Sample ID: 2023-10-24-25
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: 10/24/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2023
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Skid Portable
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Job Site
Pavement Surface Type: JPCP (Jointed Plain Concrete Pavement)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 02-Sha-5
Direction of Travel: North
Post Mile:
Lanes to be Tested: Shoulder
Station:
DIME Test ID: 2023-10-24-25-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 10/24/2023
Date Tested: 10/24/2023
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: does not comply
Additional Comments When Verified:
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Pavement or Bridge Deck?
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Pavement
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Average Coefficient of Friction
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0.28
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