Sample Taken Date	05/31/2024	Sample Unique Key	6
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	05/31/2024
Sample type	Quality Control	A brief description of the sample	1", 3/8", WCS
The quantity of what the sample constitutes	1 Bag of each	From where was the sample collected	Job Site
First name of sampler or witnessed by	Chris	Last name of sampler or witnessed by	Elias
Title of sampler	Materials Tester	Telephone number of sampler
Laboratory sample identification	163411	Linked DIME Sample ID	Unknown
The fabricator/manufacturer/facility name	Security Paving Company	Transportation Laboratory (TL) Number	Unknown
Inspector Lot Number from the Transportation Laboratory (TL) Form	Unknown	Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-10-0010
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	Belt Cut
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number	163411	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2024-05-31-6-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2024-05-31-6-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2024-05-31-6-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2024-05-31-6-4 CTM 227-December 2014 (Verified)