Sample Taken Date	03/27/2026	Sample Unique Key	6
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	03/27/2026
Sample type	Acceptance	A brief description of the sample	1x 4 Pcc Aggregate, Sand
The quantity of what the sample constitutes	50 lbs aggregate for concrete	From where was the sample collected	Fabricator
First name of sampler or witnessed by	Barrett	Last name of sampler or witnessed by	Felder
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Golden empire Wasco	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	52 - CONCRETE BARRIER (TYPE 836B)

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-15-0041
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	Conveyor Belt
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number	NCT09014	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2026-03-27-6-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2026-03-27-6-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2026-03-27-6-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2026-03-27-6-4 CTM 202-November 2011 (Verified)