Sample Taken Date	12/11/2019	Sample Unique Key	61
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	12/12/2019
Sample type	Preliminary	A brief description of the sample	Native Soil
The quantity of what the sample constitutes	1 BAG	From where was the sample collected	Job Site
First name of sampler or witnessed by	JOSE	Last name of sampler or witnessed by	GUZMAN
Title of sampler	MREA	Telephone number of sampler
Laboratory sample identification	8980	Linked DIME Sample ID	2019-12-11-61
The fabricator/manufacturer/facility name	Native Material	Transportation Laboratory (TL) Number	A-19-002 PM 37 05
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Soil	The fabricator's/manufacturer's product name for the sample	Unknown
The fabricator/manufacturer designation for the sample	Unknown	A detailed description of where the material sample was collected	0-5FT DEPTH NATIVE SOIL
Where the material sample would have been placed if not sampled	Unknown

DIME Test ID: 2019-12-11-61-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2019-12-11-61-2 CTM 204-June 2010 (Verified)
DIME Test ID: 2019-12-11-61-3 CTM 301-March 2000 (Verified)
DIME Test ID: 2019-12-11-61-4 CTM 643-June 2007 (Verified)