Sample Taken Date	10/03/2024	Sample Unique Key	4
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	10/03/2024
Sample type	Aggregate Prequalification Program	A brief description of the sample	3/8" PEA GRAVEL
The quantity of what the sample constitutes	10 Bags	From where was the sample collected	Source
First name of sampler or witnessed by	William	Last name of sampler or witnessed by	Lucas
Title of sampler	QC Supervisor	Telephone number of sampler	661-9028196
Laboratory sample identification	1123164377	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Granite Construction - Big Rock	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-19-0046
The fabricator's/manufacturer's product name for the sample	3/8" PEA GRAVEL	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	from a stock production pile
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	3/8 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	1826

DIME Test ID: 2024-10-03-4-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2024-10-03-4-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2024-10-03-4-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2024-10-03-4-4 CTM 214-August 2010 (Verified)