Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993346 DEA: 042K1904 EFIS: 0416000380
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF,SM-101,1-2.0-2.84,R44.2
Work Description: Bridge removal, struct conc bridge, clean-paint steel, MGS & lighting.
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SAN MATEO COUNTY AND IN THE CITY AND COUNTY OF SAN FRANCISCO AT VARIOUS LOCATIONS.
Contractor Name: Disney Construction
Contractor Address: 533 airport Blvd, Suite 120, Burlingame, CA 94010
Resident Engineer: Charles Koos Structure Rep.: Ehab Wahed
DIME Sample ID: 2023-04-19-24
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: 04/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/19/2023
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Skid Testing
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Job Site
DIME Test ID: 2023-04-19-24-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 04/21/2023
Date Tested: 04/19/2023
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:
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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0.35
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