Sample Taken Date	03/08/2019	Sample Unique Key	21
Will the laboratory/organization for which you are a member perform testing on this material sample?	No	Date that the sample was received by the laboratory/organization performing the testing	Not set
Sample type	Aggregate Prequalification Program	A brief description of the sample	Washed 1 1/2 Crushed Rock
The quantity of what the sample constitutes	160 lbs	From where was the sample collected	Source
First name of sampler or witnessed by	Tyler	Last name of sampler or witnessed by	Lavorci
Title of sampler	QC Technician	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Azusa Fish Canyon	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)	91-19-0035::FISH CANYON QUARRY
The fabricator's/manufacturer's product name for the sample	Washed 1 1/2 Crushed Rock	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Stockpile @ Plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1-1/2 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2019-03-08-21-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2019-03-08-21-2 CTM 211-May 2010 (Verified)
DIME Test ID: 2019-03-08-21-3 CTM 227-December 2014 (Verified)
DIME Test ID: 2019-03-08-21-4 CTM 214-August 2010 (Verified)