Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000084 DEA: 101R5604 EFIS: 1023000177
QA Service Level: 1
DIST-CO-RTE-PM: 10-CAL,SJ-5,26,99-Var
Work Description: INSTALL HIGH FRICTION SURFACE TREATMENT AND REPLACE DELINEATION.
Location Description: CALAVERAS AND SAN JOAQUIN COUNTIES AT VARIOUS LOCATIONS
Contractor Name: Q&D CONSTRUCTION LLC
Contractor Address: 1050 S 21st STREET, SPARKS, NV 89431
Resident Engineer: Troy Scheiber Structure Rep.: Unknown
DIME Sample ID: 2024-08-23-8
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: 08/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/23/2024
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: 99/4 Conn
The fabricator/manufacturer/facility name: Job Site
Pavement Surface Type: Other
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE:
Direction of Travel: North
Post Mile:
Lanes to be Tested: Lane #1
Station:
DIME Test ID: 2024-08-23-8-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 08/23/2024
Date Tested: 08/23/2024
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: N99/W4 Conn
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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