Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995175 DEA: 043W7504 EFIS: 0422000032
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-680-R12.6/24.3
Work Description: POLYESTER CONCRETE OVERLAY.
Location Description: CONTRA COSTA COUNTY AT VARIOUS LOCATIONS FROM 0.1 MILE SOUTH OF RUDGEAR ROAD UNDERCROSSING TO 0.1 MILE NORTH OF MOCOCO OVERHEAD
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST, LLC dba ACC WEST COAST
Contractor Address: 2990 Bar Vista Court, Benicia, CA 94510
Resident Engineer: Rabindra Mukherjee Structure Rep.: John K. Parecadan
DIME Sample ID: 2024-06-05-43
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 06/05/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/05/2024
The quantity of what the sample constitutes: POLYESTER
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: 2024-06-05-43-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 06/13/2024
Date Tested: 06/13/2024
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: RUDGEAR RD UC/BR#28-0059
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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0.41
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