Sample Taken Date	08/10/2020	Sample Unique Key	29
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	08/10/2020
Sample type	Quality Assurance	A brief description of the sample	3/4" Class II AB
The quantity of what the sample constitutes	not provided	From where was the sample collected	Job Site
First name of sampler or witnessed by	Dave	Last name of sampler or witnessed by	Lockett
Title of sampler		Telephone number of sampler
Laboratory sample identification	D78563	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Northstate Asphalt	Transportation Laboratory (TL) Number	002343
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)	Tullis - Northstate Asphalt
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Windrow
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	3/4 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2020-08-10-29-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2020-08-10-29-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2020-08-10-29-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2020-08-10-29-4 CTM 301-March 2000 (Verified)