Sample Taken Date	05/14/2022	Sample Unique Key	33
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	Department Acceptance	A brief description of the sample	Class 2 Aggregate Base for LCBRS
The quantity of what the sample constitutes	444 CY	From where was the sample collected	Job Site
First name of sampler or witnessed by	Kevin	Last name of sampler or witnessed by	Hopkins
Title of sampler	Plant Inspector	Telephone number of sampler	213-792-4793
Laboratory sample identification	6474	Linked DIME Sample ID
The fabricator/manufacturer/facility name	LB Crushing	Transportation Laboratory (TL) Number	C051422
Inspector Lot Number from the Transportation Laboratory (TL) Form	KH122V	Structure unique identifier
Structure name

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	LB Crushing: CMB / CL 2 BASE
The fabricator's/manufacturer's product name for the sample	LCBRS Mix	The fabricator/manufacturer designation for the sample	Flatiron West
The plant number	Flatiron Volumetric	A detailed description of where the material sample was collected	Stockpile @ Yard
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	fine
The concrete mix design number	FIW 0110-1	Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2022-05-14-33-2 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-05-14-33-3 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-05-14-33-4 CTM 226-July 2010 (Verified)
DIME Test ID: 2022-05-14-33-5 CTM 202-November 2011 (Verified)