Sample Taken Date	01/12/2024	Sample Unique Key	26
Date that the sample was received by the laboratory/organization performing the testing	01/17/2024	Sample type	Department Acceptance
A brief description of the sample	4X8 PCC cylinders	The quantity of what the sample constitutes	130 CY
From where was the sample collected	Job Site	First name of sampler or witnessed by	Noura
Last name of sampler or witnessed by	Alayyan	Title of sampler	Assistant Structure Representative
Telephone number of sampler		Laboratory sample identification	24-002
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Powell Constructors
Transportation Laboratory (TL) Number	41977818	Inspector Lot Number from the Transportation Laboratory (TL) Form
Structure unique identifier		Structure name
Bid Item	Not set

Material Type	Concrete	The concrete mix design number	1610974
The truck number from where the sample was collected	48052	The batch plant ticket number from where the sample was collected	41977815
Concrete batch plant	NA	The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	truck chute	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2024-01-12-26-1 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-01-12-26-2 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-01-12-26-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-01-12-26-4 CTM 521-June 2020 (Verified)