Sample Taken Date	01/12/2022	Sample Unique Key	56
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	02/08/2022
Sample type	Verification	A brief description of the sample	Tank 10027
The quantity of what the sample constitutes	2 of 2	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Gustavo	Last name of sampler or witnessed by	Moreno
Title of sampler		Telephone number of sampler
Laboratory sample identification	011222-048	Linked DIME Sample ID
The fabricator/manufacturer/facility name	South Gate, CA	Transportation Laboratory (TL) Number
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
Sublot number		Tank number	10027
Time of sample		HMA Supplier
Certified Asphalt Supplier	Lunday Thagard Company-World Oil - South Gate CA	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-01-12-56-2 AASHTO T315-20 (Verified)
DIME Test ID: 2022-01-12-56-3 AASHTO T315-20 (Verified)
DIME Test ID: 2022-01-12-56-4 AASHTO T315-20 (Verified)
DIME Test ID: 2022-01-12-56-5 AASHTO T313-19 (Verified)