Sample Taken Date	10/17/2025	Sample Unique Key	34
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	10/28/2025
Sample type	Aggregate Prequalification Program	A brief description of the sample	coarse aggregate
The quantity of what the sample constitutes	8 Bags	From where was the sample collected	Source
First name of sampler or witnessed by	Bryan	Last name of sampler or witnessed by	Dorsch
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Big Rock Creek - LEBATA	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)	91-19-0054
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
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: 2025-10-17-34-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-10-17-34-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2025-10-17-34-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2025-10-17-34-4 CTM 214-August 2010 (Verified)