Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994090 DEA: 01434804 EFIS: 0100000672
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-1-62.0/62.3
Work Description: Pudding Creek Bridge Widening
Location Description: MENDOCINO COUNTY IN FORT BRAGG FROM ELM STREET TO PUDDING CREEK ROAD 421
Contractor Name: MCM Construction, Inc.
Contractor Address: P.O. Box 620, North Highland, CA 95660
Resident Engineer: Roozbeh Hadipour Structure Rep.: David Rivas
DIME Sample ID: 2023-08-15-27
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: 08/15/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/15/2023
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Skid Portable
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: 2023-08-15-27-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 08/16/2023
Date Tested: 08/15/2023
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:
|
Pavement or Bridge Deck?
|
Bridge Deck
|
|
Average Coefficient of Friction
|
0.35
|
