Sample Taken Date	03/09/2022	Sample Unique Key	27
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	04/15/2022
Sample type	Verification	A brief description of the sample	Tank 32
The quantity of what the sample constitutes	2 of 2, split sample	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Severino	Last name of sampler or witnessed by	Gorospe
Title of sampler		Telephone number of sampler
Laboratory sample identification	1220301330	Linked DIME Sample ID	2022-03-09-25
The fabricator/manufacturer/facility name	Benicia, CA	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 64-16
Modified	No	Lot number
Sublot number		Tank number	32
Time of sample	0600	HMA Supplier
Certified Asphalt Supplier	Valero Marketing & Supply - Benicia CA	Multigrade	Yes
Multigrade Type	PG 64-16 / PG 64-10	Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-03-09-27-1 AASHTO T315-20 (Verified)
DIME Test ID: 2022-03-09-27-2 AASHTO T315-20 (Verified)
DIME Test ID: 2022-03-09-27-3 AASHTO T315-20 (Verified)
DIME Test ID: 2022-03-09-27-4 AASHTO T313-19 (Verified)