Sample Taken Date	05/15/2025	Sample Unique Key	3
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	05/15/2025
Sample type	Quality Assurance	A brief description of the sample	1x4 concrete aggregates, sand
The quantity of what the sample constitutes	2 Bags	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Chris	Last name of sampler or witnessed by	Palmer
Title of sampler	TET	Telephone number of sampler
Laboratory sample identification	250515-1 590RN1010	Linked DIME Sample ID
The fabricator/manufacturer/facility name	CalPortland Cement Paso Robles, CA	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name	Wellsona UC Abutment 2	Bid Item	Not set

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-40-0013
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	1 inch
The concrete mix design number	590RN1010	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2025-05-15-3-1 CTM 227-December 2014 (Verified)
DIME Test ID: 2025-05-15-3-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-05-15-3-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2025-05-15-3-4 CTM 202-November 2011 (Verified)