Sample Taken Date	07/29/2023	Sample Unique Key	2
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	07/31/2023
Sample type	Department Acceptance	A brief description of the sample	Ready Mix Concrete
The quantity of what the sample constitutes	0 - 50 Cubic Yards	From where was the sample collected	Job Site
First name of sampler or witnessed by	Jeffery	Last name of sampler or witnessed by	Puente
Title of sampler	QA	Telephone number of sampler	6614400636
Laboratory sample identification	Conc-01	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Mammoth Ready Mix	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name	Crestview

Material Type	Concrete	The concrete mix design number	1302-25590
The truck number from where the sample was collected	77	The batch plant ticket number from where the sample was collected	54428
Concrete batch plant	Mammoth	The fabricator/manufacturer designation for the sample	Mammoth Ready Mix
A detailed description of where the material sample was collected	Cinder Shed Footings	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2023-07-29-2-5 CTM 521-June 2020 (Verified)
DIME Test ID: 2023-07-29-2-6 CTM 521-June 2020 (Verified)
DIME Test ID: 2023-07-29-2-7 CTM 521-June 2020 (Verified)
DIME Test ID: 2023-07-29-2-8 CTM 521-June 2020 (Verified)