Sample Taken Date	05/25/2022	Sample Unique Key	72
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	06/20/2022
Sample type	Acceptance	A brief description of the sample	JMF - binder
The quantity of what the sample constitutes	2 cans	From where was the sample collected	Source
First name of sampler or witnessed by	C	Last name of sampler or witnessed by	Bryant
Title of sampler	TET	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Albina - Klamath Falls, OR	Transportation Laboratory (TL) Number	708120
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Asphalt Binder	Performance Grade	PG 58-34 M
Modified	Yes	Lot number
Sublot number		Tank number
Time of sample		HMA Supplier
Certified Asphalt Supplier	Albina Asphalt - Klamath Falls Plant - Klamath Falls OR	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-05-25-72-1 AASHTO T315-20 (Verified)
DIME Test ID: 2022-05-25-72-2 AASHTO T315-20 (Verified)
DIME Test ID: 2022-05-25-72-3 AASHTO T315-20 (Verified)
DIME Test ID: 2022-05-25-72-4 AASHTO T313-19 (Verified)