Sample Taken Date	07/08/2022	Sample Unique Key	94
Date that the sample was received by the laboratory/organization performing the testing	08/01/2022	Sample type	Aggregate Prequalification Program
A brief description of the sample	Washed Concrete Sand	The quantity of what the sample constitutes	production stockpile.
From where was the sample collected	Manufacturer	First name of sampler or witnessed by	Jeff
Last name of sampler or witnessed by	Clason	Title of sampler	Lab Technician
Telephone number of sampler	916-386-6974	Laboratory sample identification	22-APPF-0115
Linked DIME Sample ID	2022-07-08-77	The fabricator/manufacturer/facility name	Teichert Materials Perkins
Transportation Laboratory (TL) Number		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)	91-34-0053
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Production stockpile
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	fine
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2022-07-08-94-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-07-08-94-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-07-08-94-3 CTM 213-December 2012 (Verified)
DIME Test ID: 2022-07-08-94-4 CTM 229-June 2011 (Verified)