Sample Taken Date	02/05/2021	Sample Unique Key	23
Date that the sample was received by the laboratory/organization performing the testing	02/07/2021	Sample type	Aggregate Prequalification Program
A brief description of the sample	3/8" crushed rock APP	The quantity of what the sample constitutes	about 140 lb
From where was the sample collected	Source	First name of sampler or witnessed by	Jordan Baker
Last name of sampler or witnessed by	Jordan Baker	Title of sampler	QC Manager
Telephone number of sampler	530-227-0982	Laboratory sample identification
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Deer Creek Rock and Asphalt
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)	91-54-0021::DEER CREEK ASPHALT
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 at plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	3/8 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2021-02-05-23-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2021-02-05-23-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2021-02-05-23-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2021-02-05-23-4 CTM 214-August 2010 (Verified)