Sample Taken Date	02/18/2019	Sample Unique Key	13
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	04/02/2019
Sample type	Quality Assurance	A brief description of the sample	Concrete Sand
The quantity of what the sample constitutes	production stockpile.	From where was the sample collected	Source
First name of sampler or witnessed by	Eric	Last name of sampler or witnessed by	Gifford
Title of sampler		Telephone number of sampler	9163866974
Laboratory sample identification	19-APPF-0080	Linked DIME Sample ID	2019-02-18-7
The fabricator/manufacturer/facility name	Teichert Materials Perkins	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)	91-34-0045::ASPEN IV SOUTH
The fabricator's/manufacturer's product name for the sample	Unknown	The fabricator/manufacturer designation for the sample	Unknown
The plant number	Unknown	A detailed description of where the material sample was collected	Stockpile
Where the material sample would have been placed if not sampled	Unknown	Primary Aggregate Nominal Size	fine
The concrete mix design number	Unknown	Lot number	1
Sublot number	1	Aggregate Mix Number	Not set

DIME Test ID: 2019-02-18-13-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2019-02-18-13-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2019-02-18-13-3 CTM 213-December 2012 (Verified)
DIME Test ID: 2019-02-18-13-4 CTM 229-June 2011 (Verified)