Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993773 DEA: 021H5004 EFIS: 0216000045
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-3,299-VAR
Work Description: STRUCT CONC BRIDGE, POLYESTER CONC OVERLAY & ROCK SLOPE PROTECTION.
Location Description: TRINITY COUNTY AT VARIOUS LOCATIONS
Contractor Name: WEST COAST CONTRACTORS INC
Contractor Address: Unknown
Resident Engineer: Mandhir Grewal Structure Rep.: Mike Sears
DIME Sample ID: 2023-09-27-30
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Department Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 09/27/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/27/2023
The quantity of what the sample constitutes: Skid Testing
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: Mule Creek
The fabricator/manufacturer/facility name: Job Site
DIME Test ID: 2023-09-27-30-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 09/28/2023
Date Tested: 09/27/2023
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:
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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0.42
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