Sample Taken Date	10/01/2024	Sample Unique Key	42
Date that the sample was received by the laboratory/organization performing the testing	10/04/2024	Sample type	Proficiency
A brief description of the sample	Asphalt Binder Sample	The quantity of what the sample constitutes	1 Can
From where was the sample collected	Source	First name of sampler or witnessed by	Christopher
Last name of sampler or witnessed by	Camargo	Title of sampler
Telephone number of sampler		Laboratory sample identification
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Ergon Asphalt and Emulsions
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 58-34 M
Modified	Yes	Lot number
Sublot number		Tank number
Time of sample		HMA Supplier
Certified Asphalt Supplier	Ergon Asphalt & Emulsions Incorporated - Las Vegas NV	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number
HMA Type	Not set	HMA Supplier Mix ID Number	Not set

DIME Test ID: 2024-10-01-42-1 AASHTO T315-22 (Verified)
DIME Test ID: 2024-10-01-42-2 AASHTO T315-22 (Verified)
DIME Test ID: 2024-10-01-42-3 AASHTO T240-17 (Verified)
DIME Test ID: 2024-10-01-42-4 AASHTO T301-22 (Verified)