Sample Taken Date	05/07/2025	Sample Unique Key	101
Date that the sample was received by the laboratory/organization performing the testing	05/08/2025	Sample type	Quality Control
A brief description of the sample	PCC	The quantity of what the sample constitutes	4 CY
From where was the sample collected	Job Site	First name of sampler or witnessed by	Kelsee
Last name of sampler or witnessed by	Holland	Title of sampler	SI
Telephone number of sampler		Laboratory sample identification	C9905
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Eureka Ready mix
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	CE675DH
The truck number from where the sample was collected	99	The batch plant ticket number from where the sample was collected	42052
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	sampled from revolving drum truck into a wheelbarrow	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2025-05-07-101-1 ASTM C143-20 (Verified)
DIME Test ID: 2025-05-07-101-2 ASTM C1064-17 (Verified)
DIME Test ID: 2025-05-07-101-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2025-05-07-101-4 CTM 521-June 2020 (Verified)