Sample Taken Date	10/22/2019	Sample Unique Key	20
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	10/22/2019
Sample type	Preliminary	A brief description of the sample	5' NATIVE SOIL
The quantity of what the sample constitutes	1 bag	From where was the sample collected	Job Site
First name of sampler or witnessed by	JOSE	Last name of sampler or witnessed by	GUZMAN
Title of sampler	MREA	Telephone number of sampler
Laboratory sample identification	8769	Linked DIME Sample ID	2019-10-22-20
The fabricator/manufacturer/facility name	Native soil	Transportation Laboratory (TL) Number	SB 215
Inspector Lot Number from the Transportation Laboratory (TL) Form	A-19-002	Structure unique identifier
Structure name

Material Type	Soil	The fabricator's/manufacturer's product name for the sample	Unknown
The fabricator/manufacturer designation for the sample	Unknown	A detailed description of where the material sample was collected	Jobsite
Where the material sample would have been placed if not sampled	Unknown

DIME Test ID: 2019-10-22-20-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2019-10-22-20-2 CTM 204-June 2010 (Verified)
DIME Test ID: 2019-10-22-20-3 CTM 301-March 2000 (Verified)
DIME Test ID: 2019-10-22-20-4 CTM 643-June 2007 (Verified)