Sample Taken Date	03/08/2023	Sample Unique Key	16
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	03/09/2023
Sample type	Department Acceptance	A brief description of the sample	Structural concrete aggs
The quantity of what the sample constitutes	300 cy	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Noah	Last name of sampler or witnessed by	Hunt
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Don Chaplin	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)	91-35-0012
The fabricator's/manufacturer's product name for the sample	1X4 and sand	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Stockpile @ Plant
Where the material sample would have been placed if not sampled	Bridge Deck	Primary Aggregate Nominal Size	1 inch
The concrete mix design number	G67534ST	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2023-03-08-16-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2023-03-08-16-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2023-03-08-16-3 CTM 227-December 2014 (Verified)
DIME Test ID: 2023-03-08-16-4 CTM 217-June 2011 (Verified)