Sample Taken Date	05/17/2022	Sample Unique Key	43
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	05/17/2022
Sample type	Preliminary	A brief description of the sample	2 bags of Soil
The quantity of what the sample constitutes	Structural Section Recommendation	From where was the sample collected	Job Site
First name of sampler or witnessed by	Brian	Last name of sampler or witnessed by	Steiner
Title of sampler	Assistant Area Materials Engineer	Telephone number of sampler
Laboratory sample identification	D79028	Linked DIME Sample ID
The fabricator/manufacturer/facility name	N/A	Transportation Laboratory (TL) Number	824599
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Soil	The fabricator's/manufacturer's product name for the sample
The fabricator/manufacturer designation for the sample		A detailed description of where the material sample was collected	02-SIS-96-41.2, at Shoulder-Ditch-Slope, 0.5 to 1.5 ft depth
Where the material sample would have been placed if not sampled	In situ

DIME Test ID: 2022-05-17-43-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-05-17-43-2 CTM 643-April 2020 (Verified)
DIME Test ID: 2022-05-17-43-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-05-17-43-4 CTM 301-March 2000 (Verified)