Sample Taken Date	09/08/2022	Sample Unique Key	10
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	09/08/2022
Sample type	Quality Assurance	A brief description of the sample	Class 2 Concrete
The quantity of what the sample constitutes	10.5 Cy	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Isaac	Last name of sampler or witnessed by	Gleffe
Title of sampler	ARET	Telephone number of sampler	18053191237
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Calportland/Donaven	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)	91-42-0014
The fabricator's/manufacturer's product name for the sample	class 2 concrete	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Stockpile Donavan plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number	590GN1010	Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2022-09-08-10-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-09-08-10-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2022-09-08-10-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-09-08-10-4 CTM 202-November 2011 (Verified)