Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994538 DEA: 010L1704 EFIS: 0121000078
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-20,101-VAR
Work Description: POLYESTER CONCRETE OVERLAY, HMA, STRUCTURAL CONCRETE, BRIDGE (RSC).
Location Description: MENDOCINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Daniel Kraft Structure Rep.: Behdad Saebi
DIME Sample ID: 2024-04-23-2
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: 04/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/23/2024
The quantity of what the sample constitutes: BRIDGE DECK PCC
A brief description of the sample: PCC
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: 2024-04-23-2-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 04/24/2024
Date Tested: 04/24/2024
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: PEITA CREEK BR 10-0133
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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0.50
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