Sample Taken Date	07/05/2024	Sample Unique Key	2
Date that the sample was received by the laboratory/organization performing the testing	07/06/2024	Sample type	Acceptance
A brief description of the sample	PPC Cylinders	The quantity of what the sample constitutes	300
From where was the sample collected	Job Site	First name of sampler or witnessed by	Martin
Last name of sampler or witnessed by	Garcia	Title of sampler	Structure Representative
Telephone number of sampler	5592469430	Laboratory sample identification
Linked DIME Sample ID		The fabricator/manufacturer/facility name	Outback Materials, Fresno
Transportation Laboratory (TL) Number		Inspector Lot Number from the Transportation Laboratory (TL) Form
Structure unique identifier	45-0014	Structure name	Empire No. 2 Canal Bridge
Bid Item	Not set

Material Type	Concrete	The concrete mix design number	72T1G36
The truck number from where the sample was collected	2	The batch plant ticket number from where the sample was collected	111
Concrete batch plant	Outback Materials	The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	Concrete from wheelbarrow	Where the material sample would have been placed if not sampled	NB Arrival and Departure Approach Slabs
From Lot No.		Bag Lot No.

DIME Test ID: 2024-07-05-2-1 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-07-05-2-2 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-07-05-2-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-07-05-2-4 CTM 521-June 2020 (Verified)