Sample Taken Date	03/19/2025	Sample Unique Key	38
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	03/20/2025
Sample type	Quality Assurance	A brief description of the sample	3/4 Asphalt Concrete Aggregate
The quantity of what the sample constitutes	500 Tons	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Honesto	Last name of sampler or witnessed by	Castillo
Title of sampler	MREAS	Telephone number of sampler	2134537563
Laboratory sample identification	008	Linked DIME Sample ID
The fabricator/manufacturer/facility name	RJ Noble Orange	Transportation Laboratory (TL) Number	C 003547
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)	91-33-0027
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number	51	A detailed description of where the material sample was collected	Cold Feed
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	3/4 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2025-03-19-38-1 AASHTO T27-14 (Verified)
DIME Test ID: 2025-03-19-38-2 AASHTO T176-08 (Verified)
DIME Test ID: 2025-03-19-38-3 CTM 226-July 2010 (Verified)
DIME Test ID: 2025-03-19-38-4 AASHTO T11-5 (Verified)