Sample Taken Date	05/07/2025	Sample Unique Key	101
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	05/08/2025
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)