Sample Taken Date	05/06/2024	Sample Unique Key	48
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	05/07/2024
Sample type	Quality Assurance	A brief description of the sample	PCC
The quantity of what the sample constitutes	247.5 CY	From where was the sample collected	Job Site
First name of sampler or witnessed by	Zack	Last name of sampler or witnessed by	Arnold
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Eureka Ready Mix	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Concrete	The concrete mix design number	E675WRF
The truck number from where the sample was collected	94	The batch plant ticket number from where the sample was collected	35663
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	Concrete sample from wheelbarrow	Where the material sample would have been placed if not sampled	barrier slab
From Lot No.		Bag Lot No.

DIME Test ID: 2024-05-06-48-1 ASTM C1064-17 (Verified)
DIME Test ID: 2024-05-06-48-2 ASTM C143-20 (Verified)
DIME Test ID: 2024-05-06-48-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-05-06-48-4 CTM 521-June 2020 (Verified)