Sample Taken Date	12/19/2013	Sample Unique Key	7583960
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	12/30/2013
Sample type	Acceptance	A brief description of the sample	Class 2 Aggregate Base
The quantity of what the sample constitutes	2 Bags	From where was the sample collected	Other
First name of sampler or witnessed by	Larry	Last name of sampler or witnessed by	Unknown
Title of sampler	Not set	Telephone number of sampler	Not set
Laboratory sample identification	3361B	Linked DIME Sample ID	Not set
The fabricator/manufacturer/facility name	I-15 SB Shoulder Sta. 9387 40	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier	Not set
Structure name	Not set

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	Unknown
The fabricator's/manufacturer's product name for the sample	Not set	The fabricator/manufacturer designation for the sample	Not set
The plant number	Not set	A detailed description of where the material sample was collected	I-15 SB Shoulder Sta. 9387 40
Where the material sample would have been placed if not sampled	Not set	Primary Aggregate Nominal Size
The concrete mix design number		Lot number	Not set
Sublot number	Not set	Aggregate Mix Number	Not set

DIME Test ID: 2013-12-19-7583960-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2013-12-19-7583960-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2013-12-19-7583960-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2013-12-19-7583960-4 CTM 301-March 2000 (Verified)