Sample Taken Date	09/12/2024	Sample Unique Key	47
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	09/12/2024
Sample type	Quality Assurance	A brief description of the sample	PCC Aggregates
The quantity of what the sample constitutes	18 CY	From where was the sample collected	Supplier
First name of sampler or witnessed by	Dan	Last name of sampler or witnessed by	Ringler
Title of sampler	Lab Technician	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Shamrock Napa Plant	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)	CEMEX Cach Creek Madison
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	Belt at Plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number	D20115EA	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2024-09-12-47-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2024-09-12-47-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2024-09-12-47-3 CTM 227-December 2014 (Verified)
DIME Test ID: 2024-09-12-47-4 CTM 217-June 2011 (Verified)