Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405,73,405,605-9.3/24.3
Work Description: (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP.
Location Description: Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2
Contractor Name: OC 405 Partners
Contractor Address: 3100 W Lake Center Dr, Santa Ana, CA 92704
Resident Engineer: Hank Alonso (reports) Structure Rep.: Alex Angha (reports)
DIME Sample ID: 2020-03-11-12
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 03/11/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/03/2020
The quantity of what the sample constitutes: 2
A brief description of the sample: Approach slap
From where was the sample collected: Job Site
Laboratory sample identification: 1200000180Rte405Magnolia St OC
Structure unique identifier: 55-1121
Structure name:
The fabricator/manufacturer/facility name: Structures
DIME Test ID: 2020-03-11-12-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 03/11/2020
Date Tested: 03/11/2020
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Pavement or Bridge Deck?
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Pavement
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Average Coefficient of Friction
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0.36
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