Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212498 DEA: 021H5204 EFIS: 0217000009
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-3,263-48.5/49.7 - 49.41
Work Description: Roadway Rehabilitation
Location Description: 02-Sis-3, 263-R46.8/R48.0, 49.07/49.41
Contractor Name: Myers-Shea JV
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Austin Henry Structure Rep.: Nicolas Jimenez
DIME Sample ID: 2023-11-07-47
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: 11/07/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/07/2023
The quantity of what the sample constitutes: Skid Tesitng
A brief description of the sample: Towed Trailer
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: SB Yreka Hwy 3
The fabricator/manufacturer/facility name: Job Site
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 02-Sis-3
Direction of Travel: South
Post Mile: 50.00
Lanes to be Tested: Lane #1
Station:
DIME Test ID: 2023-11-07-47-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 11/08/2023
Date Tested: 11/07/2023
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: does not comply
Additional Comments When Verified:
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Pavement or Bridge Deck?
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Pavement
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Average Coefficient of Friction
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0.14
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