Sample Taken Date	10/30/2025	Sample Unique Key	24
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	10/30/2025
Sample type	Quality Assurance	A brief description of the sample	1 x 4 PCC Aggregate
The quantity of what the sample constitutes	220 CY load 221 x 4	From where was the sample collected	Supplier
First name of sampler or witnessed by	jesse	Last name of sampler or witnessed by	Gomez
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Granite Padaro Plant	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)	91-40-0035
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	Conveyer Belt
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: 2025-10-30-24-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-10-30-24-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2025-10-30-24-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2025-10-30-24-4 CTM 227-December 2014 (Verified)