Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993333 DEA: 04264724 EFIS: 0419000068
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-R20.8/27.1
Work Description: CIP BRIDGES, CONSTRUCT ROADWAY, RETAINING WALLS AND MODIFY ELECTRICAL.
Location Description: MARIN COUNTY IN AND NEAR NOVATO FROM 0.1 MILE SOUTH OF FRANKLIN AVENUE OVERHEAD TO 0.5 MILE SOUTH OF SAN ANTONIO CREEK BRIDGE
Contractor Name: GHILOTTI CONSTRUCTION CO. INC. (RILEY GENAZZI & JOSH SERAFINO)
Contractor Address: 246 GHILOTTI AVE., SANTA ROSA, CA 95407
Resident Engineer: Fabio La Serna Structure Rep.: Jeremy Light
DIME Sample ID: 2023-03-27-4
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: 03/27/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/27/2023
The quantity of what the sample constitutes: BRIDGE
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:
The fabricator/manufacturer/facility name: SKID TEST
DIME Test ID: 2023-03-27-4-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 03/27/2023
Date Tested: 03/27/2023
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: OLIVE AVE UC/20-0092L
Test Result Compliance: does not comply
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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0.27
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