Sample Taken Date	06/04/2025	Sample Unique Key	67
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	06/05/2025
Sample type	Quality Assurance	A brief description of the sample	Concrete Sand
The quantity of what the sample constitutes	19 CY WB Approach Slab	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Christian	Last name of sampler or witnessed by	Sousa
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Cemex Fairfield	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)	91-57-0008
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	Belt Cut at Plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	fine
The concrete mix design number	1615759	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2025-06-04-67-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-06-04-67-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-06-04-67-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2025-06-04-67-4 CTM 226-July 2010 (Verified)