Sample Taken Date	07/13/2023	Sample Unique Key	13
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	07/14/2023
Sample type	Department Acceptance	A brief description of the sample	ISR_RSC
The quantity of what the sample constitutes	1 bags aggregate and 1 bag sand	From where was the sample collected	Source
First name of sampler or witnessed by	Neale	Last name of sampler or witnessed by	Brown
Title of sampler	Materials Tester	Telephone number of sampler	6615498281
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	CTS SHORT LOAD RAPID SET	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-19-0046
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	truck15 jobsite
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number	CTS-65-GBR	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2023-07-13-13-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2023-07-13-13-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2023-07-13-13-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2023-07-13-13-4 CTM 227-December 2014 (Verified)