Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000091 DEA: 032G5404 EFIS: 0321000237
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-128,505-VAR
Work Description: PLACE AND FURNISH POLYESTER CONCRETE OVERLAY, & REPLACE JOINT SEALS.
Location Description: YOLO COUNTY AT VARIOUS LOCATIONS
Contractor Name: BRIDGEWAY CIVIL CONSTRUCTORS, INC.
Contractor Address: 3333 Vaca Valley Parkway, Suite 2000, Vacaville, CA 95688
Resident Engineer: Nimi Badwalz Structure Rep.: Brent Bullard
DIME Sample ID: 2024-09-17-48
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: 09/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/17/2024
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: Polyester Slab 12'x9'
The fabricator/manufacturer/facility name: Job Site
DIME Test ID: 2024-09-17-48-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 09/19/2024
Date Tested: 09/17/2024
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:
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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0.43
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