Sample Taken Date	05/24/2021	Sample Unique Key	20
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	05/25/2021
Sample type	Department Acceptance	A brief description of the sample	top sand
The quantity of what the sample constitutes	1 bag	From where was the sample collected	Source
First name of sampler or witnessed by	zao	Last name of sampler or witnessed by	Reid
Title of sampler	CHMW	Telephone number of sampler
Laboratory sample identification	21-0101	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Echo Summit Yard South Lake Tahoe	Transportation Laboratory (TL) Number	c
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)	not provided
The fabricator's/manufacturer's product name for the sample	Top Sand	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Cinderlite top sand
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	fine
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2021-05-24-20-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2021-05-24-20-2 CTM 226-July 2010 (Verified)
DIME Test ID: 2021-05-24-20-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2021-05-24-20-4 CTM 217-June 2011 (Verified)