Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995083 DEA: 051R1604 EFIS: 0523000152
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-82.18, 82.2/82.2
Work Description: Repair high-load hit
Location Description: Near Santa Maria, US101 and Clark Ave overcrossing.
Contractor Name: SOUZA CONSTRUCTION
Contractor Address: 4027 Santa Fe Road, San Luis Obispo, CA 93403
Resident Engineer: Albert Reed Structure Rep.: Alis Chhay
DIME Sample ID: 2024-06-11-16
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: 06/11/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/11/2024
The quantity of what the sample constitutes: BRIDGE DECK
A brief description of the sample: PCC
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: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Moving Lane Closure
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested:
Station:
DIME Test ID: 2024-06-11-16-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 06/11/2024
Date Tested: 06/11/2024
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: CLARK AVENUE OC/BR#51-0232
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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0.36
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