Sample Taken Date	12/06/2019	Sample Unique Key	12
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	12/06/2019
Sample type	Aggregate Prequalification Program	A brief description of the sample	1" Gravel
The quantity of what the sample constitutes	150 lbs	From where was the sample collected	Source
First name of sampler or witnessed by	Manolito Limos	Last name of sampler or witnessed by	Limos
Title of sampler	Technical Services Specialist	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Vulcan Sun Valley Boulevard	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)	91-19-0019::BOULEVARD
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	Stockpile @ Plant
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	Unknown
Sublot number	Unknown	Aggregate Mix Number	Not set

DIME Test ID: 2019-12-06-12-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2019-12-06-12-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2019-12-06-12-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2019-12-06-12-4 CTM 214-August 2010 (Verified)