Sample Taken Date	08/18/2026	Sample Unique Key	32
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	08/19/2026
Sample type	Preliminary	A brief description of the sample	PCC for CRPC
The quantity of what the sample constitutes	Concrete Field Qualification	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Leif	Last name of sampler or witnessed by	Ayres
Title of sampler	MREAS	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Tidewater Stary Pit	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Concrete	The concrete mix design number	TWC-CT675PAV
The truck number from where the sample was collected	121	The batch plant ticket number from where the sample was collected	4115
Concrete batch plant	Tidewater Stary Pit	The fabricator/manufacturer designation for the sample	Qualification
A detailed description of where the material sample was collected	Concrete Chute	Where the material sample would have been placed if not sampled	N/A
From Lot No.		Bag Lot No.

DIME Test ID: 2026-08-18-32-1 CTM 521-June 2020 (Verified)
DIME Test ID: 2026-08-18-32-2 CTM 521-June 2020 (Verified)
DIME Test ID: 2026-08-18-32-4 CTM 504-June 2010 (Verified)
DIME Test ID: 2026-08-18-32-5 CTM 521-June 2020 (Verified)