Sample Taken Date	08/19/2014	Sample Unique Key	8
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	08/19/2014
Sample type	Acceptance	A brief description of the sample	Class 3 Aggregate Base
The quantity of what the sample constitutes	1 Bucket	From where was the sample collected	Source
First name of sampler or witnessed by	Dan	Last name of sampler or witnessed by	Chapman
Title of sampler	Unknown	Telephone number of sampler	Unknown
Laboratory sample identification	4235B	Linked DIME Sample ID	0
The fabricator/manufacturer/facility name	Unknown	Transportation Laboratory (TL) Number	Unknown
Inspector Lot Number from the Transportation Laboratory (TL) Form	Unknown	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	Unknown	The fabricator/manufacturer designation for the sample	Unknown
The plant number	Unknown	A detailed description of where the material sample was collected	210 Fwy crushing site west of Latunga Canyon
Where the material sample would have been placed if not sampled	Unknown	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: 2014-08-19-8-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2014-08-19-8-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2014-08-19-8-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2014-08-19-8-4 CTM 301-March 2000 (Verified)