Sample Taken Date	07/08/2021	Sample Unique Key	67
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	07/08/2021
Sample type	Aggregate Prequalification Program	A brief description of the sample	#4 Washed PCC Sand
The quantity of what the sample constitutes	4 bags of aggregate	From where was the sample collected	Source
First name of sampler or witnessed by	Daniel	Last name of sampler or witnessed by	Miltz
Title of sampler	QC Technician	Telephone number of sampler
Laboratory sample identification	1390912612	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Granite Handley Ranch Quarry	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)	91-27-0028::HANDLEY RANCH QUARRY
The fabricator's/manufacturer's product name for the sample	No. 4 Washed PCC Sand	The fabricator/manufacturer designation for the sample
The plant number	1766	A detailed description of where the material sample was collected	Stockpile sample
Where the material sample would have been placed if not sampled	Use in Salinas Hot Plant	Primary Aggregate Nominal Size	fine
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2021-07-08-67-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2021-07-08-67-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2021-07-08-67-3 CTM 213-December 2012 (Verified)
DIME Test ID: 2021-07-08-67-4 CTM 229-June 2011 (Verified)