Sample Taken Date	07/14/2022	Sample Unique Key	80
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	08/01/2022
Sample type	Department Acceptance	A brief description of the sample	PG 58-34M
The quantity of what the sample constitutes	1 can	From where was the sample collected	Source
First name of sampler or witnessed by	C	Last name of sampler or witnessed by	Rogers
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Valero Benicia	Transportation Laboratory (TL) Number	851756
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
Time of sample		HMA Supplier
Certified Asphalt Supplier	Valero Marketing & Supply - Benicia CA	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-07-14-80-1 AASHTO T315-20 (Verified)
DIME Test ID: 2022-07-14-80-2 AASHTO T315-20 (Verified)
DIME Test ID: 2022-07-14-80-3 AASHTO T315-20 (Verified)
DIME Test ID: 2022-07-14-80-4 AASHTO T313-19 (Verified)