Sample Taken Date	09/16/2024	Sample Unique Key	64
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	09/20/2024
Sample type	Verification	A brief description of the sample	JMF Verification
The quantity of what the sample constitutes	1 OF 1	From where was the sample collected	Source
First name of sampler or witnessed by	A.	Last name of sampler or witnessed by	Cook
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Kerman Plant, Blue Lake	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Asphalt Binder	Performance Grade	PG 64-28 M
Modified	Yes	Lot number
Sublot number		Tank number
Time of sample		HMA Supplier	Granite Kernan Plant
Certified Asphalt Supplier	Valero Marketing & Supply - Benicia CA	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number

DIME Test ID: 2024-09-16-64-1 AASHTO T315-22 (Verified)
DIME Test ID: 2024-09-16-64-5 AASHTO T301-22 (Verified)
DIME Test ID: 2024-09-16-64-6 AASHTO T315-22 (Verified)
DIME Test ID: 2024-09-16-64-7 AASHTO T315-22 (Verified)