Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994128 DEA: 043W5304 EFIS: 0421000385
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-680-1.09
Work Description: POLYESTER CONCRETE OVERLAY AND GRIND EXISTING CONCRETE PAVEMENT.
Location Description: BRIDGE DECK PROGRAM
Contractor Name: MYERS & SONS CONSTRUCTION LLC
Contractor Address: Unknown
Resident Engineer: Rabindra Mukherjee Structure Rep.: Unknown
DIME Sample ID: 2023-05-18-22
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: 05/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/18/2023
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: 2023-05-18-22-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 05/20/2023
Date Tested: 05/18/2023
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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0.41
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