Sample Taken Date	10/27/2021	Sample Unique Key	32
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	12/02/2021
Sample type	Department Acceptance	A brief description of the sample	binder
The quantity of what the sample constitutes	1 can	From where was the sample collected	Source
First name of sampler or witnessed by	Paul	Last name of sampler or witnessed by	Klinker
Title of sampler	TET	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	San Joaquin Refinery	Transportation Laboratory (TL) Number	056279
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Asphalt Binder	Performance Grade	PG 64-10
Modified		Lot number
Sublot number		Tank number
Time of sample		HMA Supplier
Certified Asphalt Supplier	San Joaquin Refinery - Bakersfield CA	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2021-10-27-32-1 AASHTO T315-20 (Verified)
DIME Test ID: 2021-10-27-32-2 AASHTO T315-20 (Verified)
DIME Test ID: 2021-10-27-32-3 AASHTO T315-20 (Verified)
DIME Test ID: 2021-10-27-32-4 AASHTO T313-19 (Verified)