Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994537 DEA: 010L1604 EFIS: 0121000077
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-1,101-Var
Work Description: POLYESTER CONCRETE OVERLAY, RAPID SETTING CONCRETE (PATCH), HMA.
Location Description: MENDOCINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: TPA CONSTRUCTION INC.
Contractor Address: 1770 Booth Road, Roseville, CA 95747
Resident Engineer: Mojtaba Mosallai Structure Rep.: Will Cudney
DIME Sample ID: 2023-11-27-8
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: 11/27/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/27/2023
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: Trial Slab
The fabricator/manufacturer/facility name: Job Site
Pavement Surface Type: Methacrylate Resin
Type of Traffic Control Provided: N/A
DIST-CO-RTE: 01-Men-1
Direction of Travel: North
Post Mile:
Lanes to be Tested: Shoulder
Station:
DIME Test ID: 2023-11-27-8-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 11/28/2023
Date Tested: 11/27/2023
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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0.48
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