Sample Taken Date	01/21/2022	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	02/16/2022
Sample type	Verification	A brief description of the sample	Asphalt Binder Sample
The quantity of what the sample constitutes	2 of 2 cans split sample	From where was the sample collected	Source
First name of sampler or witnessed by	Thomas	Last name of sampler or witnessed by	Ludlum
Title of sampler		Telephone number of sampler
Laboratory sample identification	22-017	Linked DIME Sample ID	2022-01-21-30
The fabricator/manufacturer/facility name	Holly Frontier Glendale, AZ	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Asphalt Binder	Performance Grade	PG 58-34 M
Modified	Yes	Lot number
Sublot number		Tank number	503
Time of sample		HMA Supplier
Certified Asphalt Supplier	Holly Frontier Asphalt Company - Glendale AZ	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-01-21-32-1 AASHTO T315-20 (Verified)
DIME Test ID: 2022-01-21-32-3 AASHTO T315-20 (Verified)
DIME Test ID: 2022-01-21-32-4 AASHTO T313-19 (Verified)
DIME Test ID: 2022-01-21-32-5 AASHTO T315-20 (Verified)