Sample Taken Date	10/04/2021	Sample Unique Key	33
Date that the sample was received by the laboratory/organization performing the testing	10/05/2021	Sample type	Department Acceptance
A brief description of the sample	3/4" Class II AB	The quantity of what the sample constitutes	2 bags
From where was the sample collected	Manufacturer	First name of sampler or witnessed by	Karl
Last name of sampler or witnessed by	Huntman	Title of sampler	JET
Telephone number of sampler		Laboratory sample identification	D78946
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Mountain Gate Quarry
Transportation Laboratory (TL) Number	853080	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)	91-45-0001
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Stockpile
Where the material sample would have been placed if not sampled	02 SIS 5	Primary Aggregate Nominal Size	1/2 inch
The concrete mix design number		Lot number	Unknown
Sublot number	Unknown	Aggregate Mix Number	Not set

DIME Test ID: 2021-10-04-33-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2021-10-04-33-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2021-10-04-33-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2021-10-04-33-4 CTM 301-March 2000 (Verified)