Sample Taken Date	09/10/2014	Sample Unique Key	9
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	09/10/2014
Sample type	Annual Source Testing	A brief description of the sample	Sand
The quantity of what the sample constitutes	1 Bag	From where was the sample collected	Source
First name of sampler or witnessed by	Thomas	Last name of sampler or witnessed by	Stinnett
Title of sampler	Unknown	Telephone number of sampler	Unknown
Laboratory sample identification	14FPCC-302 C638417C	Linked DIME Sample ID	0
The fabricator/manufacturer/facility name	Confab KRC	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)	NA
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
Where the material sample would have been placed if not sampled	Unknown	Primary Aggregate Nominal Size	fine
The concrete mix design number		Lot number	Not set
Sublot number	Not set	Aggregate Mix Number	Not set

DIME Test ID: 2014-09-10-9-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2014-09-10-9-2 CTM 213-December 2012 (Verified)
DIME Test ID: 2014-09-10-9-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2014-09-10-9-4 CTM 229-June 2011 (Verified)