| Sample Taken Date | 12/10/2021 |
Sample Unique Key | 1 |
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| 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 | 12/14/2021 |
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| Sample type | Per Request |
A brief description of the sample | Soil Sample Native Selected |
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| The quantity of what the sample constitutes | 2 sand bags each approx 20 lbs |
From where was the sample collected | Source |
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| First name of sampler or witnessed by | Waqas |
Last name of sampler or witnessed by | Ather |
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| Title of sampler | METS Rep |
Telephone number of sampler | 6099681702 |
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| Laboratory sample identification | |
Linked DIME Sample ID | |
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| The fabricator/manufacturer/facility name | US 101/Manuel T Freitas Parkway (MFP) Interchange in the City of San Rafael |
Transportation Laboratory (TL) Number | |
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| Inspector Lot Number from the Transportation Laboratory (TL) Form | |
Structure unique identifier | |
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| Structure name | |
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