Sample Taken Date	12/11/2019	Sample Unique Key	56
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	12/11/2019
Sample type	Aggregate Prequalification Program	A brief description of the sample	WCS PCC Aggregate
The quantity of what the sample constitutes	120 lbs	From where was the sample collected	Source
First name of sampler or witnessed by	Manolito	Last name of sampler or witnessed by	Limos
Title of sampler	QC Specialist	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Vulcan Materials Durbin	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)	91-19-0023::DURBIN
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	Plant 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	Unknown
Sublot number	Unknown	Aggregate Mix Number	Not set

DIME Test ID: 2019-12-11-56-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2019-12-11-56-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2019-12-11-56-3 CTM 213-December 2012 (Verified)
DIME Test ID: 2019-12-11-56-4 CTM 229-June 2011 (Verified)