Sample Taken Date	09/10/2025	Sample Unique Key	90
Will the laboratory/organization for which you are a member perform testing on this material sample?	No	Date that the sample was received by the laboratory/organization performing the testing	09/10/2025
Sample type	Aggregate Prequalification Program	A brief description of the sample	1" Coarse Aggregate
The quantity of what the sample constitutes	6 Bags	From where was the sample collected	Supplier
First name of sampler or witnessed by	Nick	Last name of sampler or witnessed by	Qualin
Title of sampler		Telephone number of sampler	858-864-3718
Laboratory sample identification		Linked DIME Sample ID	2025-09-10-12
The fabricator/manufacturer/facility name	Maitri Road Sand and Gravel	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)	91-33-0011
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 @ Plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2025-09-10-90-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-09-10-90-2 CTM 211-May 2010 (Verified)
DIME Test ID: 2025-09-10-90-3 CTM 214-August 2010 (Verified)
DIME Test ID: 2025-09-10-90-4 CTM 227-December 2014 (Verified)