Sample Taken Date	06/21/2022	Sample Unique Key	49
Date that the sample was received by the laboratory/organization performing the testing	06/24/2022	Sample type	Department Acceptance
A brief description of the sample	6X12 PCC cylinder	The quantity of what the sample constitutes	130 CY
From where was the sample collected	Job Site	First name of sampler or witnessed by	David
Last name of sampler or witnessed by	Bar-On	Title of sampler	Assistant Structure Representative
Telephone number of sampler		Laboratory sample identification	22-0164
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Holiday Rock
Transportation Laboratory (TL) Number	NA	Inspector Lot Number from the Transportation Laboratory (TL) Form
Structure unique identifier		Structure name
Bid Item	Not set

Material Type	Concrete	The concrete mix design number	3C50L001
The truck number from where the sample was collected		The batch plant ticket number from where the sample was collected	NA
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	truck chute	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2022-06-21-49-1 CTM 521-June 2020 (Verified)
DIME Test ID: 2022-06-21-49-2 CTM 521-June 2020
DIME Test ID: 2022-06-21-49-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2022-06-21-49-4 CTM 521-June 2020 (Verified)