Sample Taken Date	03/07/2022	Sample Unique Key	9
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	03/14/2022
Sample type	Department Acceptance	A brief description of the sample	BINDER
The quantity of what the sample constitutes	1 OF 1	From where was the sample collected	Source
First name of sampler or witnessed by	THOMAS	Last name of sampler or witnessed by	ILLIFFE
Title of sampler		Telephone number of sampler
Laboratory sample identification	GARCO 1635433720	Linked DIME Sample ID
The fabricator/manufacturer/facility name	GRANITE	Transportation Laboratory (TL) Number	035681
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Asphalt Binder	Performance Grade	PG 58-22
Modified	No	Lot number
Sublot number		Tank number
Time of sample		HMA Supplier
Certified Asphalt Supplier	Valero Marketing & Supply - Benicia CA	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-03-07-9-1 AASHTO T315-20 (Verified)
DIME Test ID: 2022-03-07-9-2 AASHTO T315-20 (Verified)
DIME Test ID: 2022-03-07-9-3 AASHTO T315-20 (Verified)
DIME Test ID: 2022-03-07-9-4 AASHTO T315-20 (Verified)