Sample Taken Date	08/12/2025	Sample Unique Key	46
Date that the sample was received by the laboratory/organization performing the testing	08/13/2025	Sample type	Quality Assurance
A brief description of the sample	PCC with slag and air entrainment.	The quantity of what the sample constitutes	11 CY
From where was the sample collected	Job Site	First name of sampler or witnessed by	Sam
Last name of sampler or witnessed by	Kaplan	Title of sampler	ASR
Telephone number of sampler	707-496-0826	Laboratory sample identification
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Mercer Fraser
Transportation Laboratory (TL) Number		Inspector Lot Number from the Transportation Laboratory (TL) Form
Structure unique identifier		Structure name	Little Larabe Creek Bridge
Bid Item	Not set

Material Type	Concrete	The concrete mix design number	MF CL 1 .40 SLAG AE
The truck number from where the sample was collected	683	The batch plant ticket number from where the sample was collected	111152
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	Concrete dischanged from the truck	Where the material sample would have been placed if not sampled	Abutment 1 wingwall
From Lot No.		Bag Lot No.

DIME Test ID: 2025-08-12-46-1 CTM 521-June 2020 (Verified)
DIME Test ID: 2025-08-12-46-2 CTM 521-June 2020 (Verified)
DIME Test ID: 2025-08-12-46-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2025-08-12-46-4 CTM 521-June 2020 (Verified)