Sample Taken Date	01/08/2022	Sample Unique Key	7
Will the laboratory/organization for which you are a member perform testing on this material sample?	No	Date that the sample was received by the laboratory/organization performing the testing	01/15/2022
Sample type	Quality Assurance	A brief description of the sample	PCCP Aggregate
The quantity of what the sample constitutes	100 cys	From where was the sample collected	Fabricator
First name of sampler or witnessed by	Gerardo	Last name of sampler or witnessed by	Zubieta
Title of sampler	Transportation Engineer	Telephone number of sampler
Laboratory sample identification	5596	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Short Load Concrete Anaheim	Transportation Laboratory (TL) Number	C924025
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)	91-33-0035
The fabricator's/manufacturer's product name for the sample	PCCP Aggregate	The fabricator/manufacturer designation for the sample
The plant number	Short Load Anaheim	A detailed description of where the material sample was collected	stock pile
Where the material sample would have been placed if not sampled	PCC SLAB	Primary Aggregate Nominal Size	1 inch
The concrete mix design number	CTS-65-EHI	Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2022-01-08-7-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-01-08-7-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2022-01-08-7-3 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-01-08-7-4 CTM 217-June 2011 (Verified)