Sample Taken Date	05/22/2015	Sample Unique Key	3
Date that the sample was received by the laboratory/organization performing the testing	05/27/2015	Sample type	Quality Control
A brief description of the sample	6x12	The quantity of what the sample constitutes	6
From where was the sample collected	Job Site	First name of sampler or witnessed by	G
Last name of sampler or witnessed by	PAREDES	Title of sampler	ASR
Telephone number of sampler	Unknown	Laboratory sample identification	901-22
Linked DIME Sample ID	Unknown	The fabricator/manufacturer/facility name	JOB
Transportation Laboratory (TL) Number	15222	Inspector Lot Number from the Transportation Laboratory (TL) Form	Unknown
Structure unique identifier	HORSETHEIF CREEK BRIDGE 54 1271	Structure name	BENT 2 AND 3 AT SPLICE AREAS
Bid Item	Not set

Material Type	Concrete	The concrete mix design number	HG78547A
The truck number from where the sample was collected	174	The batch plant ticket number from where the sample was collected	822026
Concrete batch plant	Unknown	The fabricator/manufacturer designation for the sample	Unknown
A detailed description of where the material sample was collected	CHUTE	Where the material sample would have been placed if not sampled	Unknown
From Lot No.	Not set	Bag Lot No.	Not set

DIME Test ID: 2015-05-22-3-1 CTM 521-November 2014 (Verified)
DIME Test ID: 2015-05-22-3-2 CTM 521-November 2014 (Verified)
DIME Test ID: 2015-05-22-3-3 CTM 521-November 2014 (Verified)
DIME Test ID: 2015-05-22-3-4 CTM 521-November 2014 (Verified)