Sample Taken Date	08/14/2014	Sample Unique Key	23
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	08/14/2014
Sample type	Department Acceptance	A brief description of the sample	Class 3 Aggregate Base
The quantity of what the sample constitutes	2 Bags	From where was the sample collected	Other
First name of sampler or witnessed by	Syed	Last name of sampler or witnessed by	Shah
Title of sampler	ARE	Telephone number of sampler	Unknown
Laboratory sample identification	4233B	Linked DIME Sample ID	0
The fabricator/manufacturer/facility name	I 5 Mainline at Sta 168 50	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier	Not set
Structure name	Not set

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	Unknown
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	I 5 Mainline at Sta 168 50
Where the material sample would have been placed if not sampled	Unknown	Primary Aggregate Nominal Size
The concrete mix design number		Lot number	Not set
Sublot number	Not set	Aggregate Mix Number	Not set

DIME Test ID: 2014-08-14-23-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2014-08-14-23-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2014-08-14-23-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2014-08-14-23-4 CTM 301-March 2000 (Verified)