Sample Taken Date	05/05/2025	Sample Unique Key	23
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	05/05/2025
Sample type	Quality Assurance	A brief description of the sample	1 x 4 PCC Aggregates
The quantity of what the sample constitutes	320 CY	From where was the sample collected	Supplier
First name of sampler or witnessed by	Mike	Last name of sampler or witnessed by	Bennett
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Granite Padaro Plant	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Concrete	The concrete mix design number	387
The truck number from where the sample was collected		The batch plant ticket number from where the sample was collected	17255
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	Discharge from concrete truck into wheelbarrow.	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2025-05-05-23-1 ASTM C1064-17 (Verified)
DIME Test ID: 2025-05-05-23-2 CTM 504-June 2010 (Verified)
DIME Test ID: 2025-05-05-23-3 CTM 533-June 2010 (Verified)
DIME Test ID: 2025-05-05-23-4 CTM 523-May 2020 (Verified)