Sample Taken Date	07/23/2025	Sample Unique Key	21
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	07/24/2025
Sample type	Acceptance	A brief description of the sample	Shoulder Backing
The quantity of what the sample constitutes	2 Bags of Shoulder Backing	From where was the sample collected	Source
First name of sampler or witnessed by	Jeff	Last name of sampler or witnessed by	Puente
Title of sampler	QA	Telephone number of sampler
Laboratory sample identification	SB - 1	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Granite Five Bridges	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)	Granite Five Bridges
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 @ Yard
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	3/8 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2025-07-23-21-1 AASHTO T27-14 (Verified)
DIME Test ID: 2025-07-23-21-2 AASHTO T176-08 (Verified)
DIME Test ID: 2025-07-23-21-3 AASHTO T335-09r13 (Verified)
DIME Test ID: 2025-07-23-21-4 CTM 229-June 2011 (Verified)