Sample Taken Date	03/04/2025	Sample Unique Key	57
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	03/05/2025
Sample type	Aggregate Prequalification Program	A brief description of the sample	3/8" Pea Gravel
The quantity of what the sample constitutes	100 pounds	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Ron	Last name of sampler or witnessed by	Novak
Title of sampler	Quality Control Representative	Telephone number of sampler
Laboratory sample identification	1171	Linked DIME Sample ID	2025-03-04-50
The fabricator/manufacturer/facility name	CEMEX Eliot Aggregates Quarry	Transportation Laboratory (TL) Number
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)	91-01-0009
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 @ Plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	3/8 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2025-03-04-57-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-03-04-57-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2025-03-04-57-4 CTM 214-August 2010 (Verified)
DIME Test ID: 2025-03-04-57-5 CTM 227-December 2014 (Verified)