Sample Taken Date	11/03/2021	Sample Unique Key	7
Will the laboratory/organization for which you are a member perform testing on this material sample?	No	Date that the sample was received by the laboratory/organization performing the testing	11/05/2021
Sample type	Aggregate Prequalification Program	A brief description of the sample	1"x#4 Washed Concrete Aggregate
The quantity of what the sample constitutes	3 Buckets	From where was the sample collected	Source
First name of sampler or witnessed by	Kyle	Last name of sampler or witnessed by	Portlock
Title of sampler	Lab Technician	Telephone number of sampler	6195929623
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Hanson Aggregates	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)	Santee
The fabricator's/manufacturer's product name for the sample	1 x 4 Concrete Agg	The fabricator/manufacturer designation for the sample
The plant number	016	A detailed description of where the material sample was collected	Stockpile
Where the material sample would have been placed if not sampled	In Concrete	Primary Aggregate Nominal Size	1 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2021-11-03-7-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2021-11-03-7-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2021-11-03-7-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2021-11-03-7-4 CTM 214-August 2010 (Verified)