Sample Taken Date	02/18/2019	Sample Unique Key	10
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	04/02/2019
Sample type	Aggregate Prequalification Program	A brief description of the sample	1" X #4 CA
The quantity of what the sample constitutes	production stockpile.	From where was the sample collected	Other
First name of sampler or witnessed by	Eric	Last name of sampler or witnessed by	Gifford
Title of sampler		Telephone number of sampler	9163866974
Laboratory sample identification	19-APPC-0077	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Teichert Materials Perkins	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-34-0045::ASPEN IV SOUTH
The fabricator's/manufacturer's product name for the sample	Unknown	The fabricator/manufacturer designation for the sample	Unknown
The plant number	Unknown	A detailed description of where the material sample was collected	Unknown
Where the material sample would have been placed if not sampled	Unknown	Primary Aggregate Nominal Size	1 inch
The concrete mix design number	Unknown	Lot number	1
Sublot number	1	Aggregate Mix Number	Not set

DIME Test ID: 2019-02-18-10-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2019-02-18-10-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2019-02-18-10-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2019-02-18-10-4 CTM 214-August 2010 (Verified)