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Sample Record for 2024-07-22-22

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 1000075 DEA: 010L9504 EFIS: 0122000067 QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101,255-VAR
Work Description: POLYESTER CONCRETE OVERLAY, HMA-A, & COLD PLANE ASPHALT CONCRETE.
Location Description: HUMBOLDT COUNTY AT VARIOUS LOCATIONS
Contractor Name: GOLDEN STATE BRIDGE, INC.
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Robin Collins Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2024-07-22-22
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Quality Assurance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 07/22/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/22/2024
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Portable Skid Test
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Test Slabs
The fabricator/manufacturer/facility name: AT THE JOB SITE

Material Information

Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: N/A
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested:
Station:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2024-07-22-22-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 07/23/2024
Date Tested: 07/22/2024
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: Polyester Trial Slab
Test Result Compliance: complies
Additional Comments When Verified:
Pavement or Bridge Deck? Bridge Deck
Average Coefficient of Friction 0.43

Test 2 of 2

DIME Test ID: 2024-07-22-22-2
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 07/23/2024
Date Tested: 07/22/2024
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: Methacrylate Trial Slab
Test Result Compliance: complies
Additional Comments When Verified:
Pavement or Bridge Deck? Bridge Deck
Average Coefficient of Friction 0.41