Sample Taken Date	10/13/2022	Sample Unique Key	69
Date that the sample was received by the laboratory/organization performing the testing	10/17/2022	Sample type	Department Acceptance
A brief description of the sample	1 x 4 PCC Aggregate	The quantity of what the sample constitutes	300 CYS
From where was the sample collected	Fabricator	First name of sampler or witnessed by	Gerardo
Last name of sampler or witnessed by	Zubieta	Title of sampler	TRANSPORTATION ENGINEER CIVIL
Telephone number of sampler		Laboratory sample identification	7904
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Vanguard at the 57 Freeway
Transportation Laboratory (TL) Number	C-924304	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)	91-19-0035
The fabricator's/manufacturer's product name for the sample	JPCP Pavement	The fabricator/manufacturer designation for the sample	Portable Plant
The plant number		A detailed description of where the material sample was collected	Conveyor Belt feeding weight hopper at the Plant
Where the material sample would have been placed if not sampled	PCC SLAB	Primary Aggregate Nominal Size	1 inch
The concrete mix design number	57030SL	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2022-10-13-69-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-10-13-69-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2022-10-13-69-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-10-13-69-4 CTM 202-November 2011 (Verified)