Sample Taken Date	10/07/2021	Sample Unique Key	112
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	11/15/2021
Sample type	Acceptance	A brief description of the sample	PG 64-16 Marathon
The quantity of what the sample constitutes	1 Can, NO TEST 10/11, 10/12, 10/14, 10/15	From where was the sample collected	Source
First name of sampler or witnessed by	Travis	Last name of sampler or witnessed by	-
Title of sampler	Unknown	Telephone number of sampler	Unknown
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Teichert - Hallwood Plant	Transportation Laboratory (TL) Number	707414
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Asphalt Binder	Performance Grade	PG 64-16
Modified	No	Lot number	7
Sublot number		Tank number
Time of sample		HMA Supplier
Certified Asphalt Supplier	Marathon Petroleum Co. LP - Elk Grove CA	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2021-10-07-112-1 AASHTO T315-20 (Verified)
DIME Test ID: 2021-10-07-112-2 AASHTO T315-20 (Verified)
DIME Test ID: 2021-10-07-112-3 AASHTO T315-20 (Verified)
DIME Test ID: 2021-10-07-112-4 AASHTO T313-19 (Verified)