Sample Taken Date	01/14/2020	Sample Unique Key	35
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	03/04/2020
Sample type	Aggregate Prequalification Program	A brief description of the sample	Washed Concrete Sand
The quantity of what the sample constitutes	150 lbs	From where was the sample collected	Source
First name of sampler or witnessed by	Joshua	Last name of sampler or witnessed by	Rider
Title of sampler		Telephone number of sampler
Laboratory sample identification	9465	Linked DIME Sample ID	2020-01-14-29
The fabricator/manufacturer/facility name	San Bernardino Cajon Creek	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)	91-36-0137::CAJON CREEK
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 @ Yard
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: 2020-01-14-35-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2020-01-14-35-2 CTM 213-December 2012 (Verified)
DIME Test ID: 2020-01-14-35-4 CTM 217-June 2011 (Verified)
DIME Test ID: 2020-01-14-35-5 CTM 229-June 2011 (Verified)