Sample Taken Date	04/15/2025	Sample Unique Key	4
Will the laboratory/organization for which you are a member perform testing on this material sample?	No	Date that the sample was received by the laboratory/organization performing the testing	04/15/2025
Sample type	Aggregate Prequalification Program	A brief description of the sample	1x4 Aggregates
The quantity of what the sample constitutes	5000 tons	From where was the sample collected	Source
First name of sampler or witnessed by	Fernando	Last name of sampler or witnessed by	Villavisencio
Title of sampler		Telephone number of sampler	9517604266
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Robertson Lucerne Quarry	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-36-0116
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Stockpile of 1x4 aggregate.
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2025-04-15-4-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-04-15-4-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2025-04-15-4-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2025-04-15-4-4 CTM 214-August 2010 (Verified)