Sample Taken Date	09/17/2021	Sample Unique Key	42
Will the laboratory/organization for which you are a member perform testing on this material sample?	Yes	Date that the sample was received by the laboratory/organization performing the testing	09/17/2021
Sample type	Aggregate Prequalification Program	A brief description of the sample	WCS, 3/4" and 1" Aggregate
The quantity of what the sample constitutes	2 Bags of WCS, 3 Bags of 3/4" and 3 Bags of 1"	From where was the sample collected	Other
First name of sampler or witnessed by	Raymond	Last name of sampler or witnessed by	Alcantara
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Fisher Sand and Gravel	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	NA
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
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	fine
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2021-09-17-42-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2021-09-17-42-2 CTM 213-December 2012 (Verified)
DIME Test ID: 2021-09-17-42-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2021-09-17-42-4 CTM 229-June 2011 (Verified)
DIME Test ID: 2021-09-17-42-5 CTM 214-August 2010 (Verified)