Sample Taken Date	06/21/2022	Sample Unique Key	58
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	07/14/2022
Sample type	Verification	A brief description of the sample	Tank 533
The quantity of what the sample constitutes	1 of 1	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Thomas	Last name of sampler or witnessed by	Ludlum
Title of sampler		Telephone number of sampler
Laboratory sample identification	22-148	Linked DIME Sample ID	2022-06-21-51
The fabricator/manufacturer/facility name	Glendale, AZ	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 70-10
Modified		Lot number
Sublot number		Tank number
Time of sample		HMA Supplier
Certified Asphalt Supplier	Holly Frontier Asphalt Company - Glendale AZ	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-06-21-58-1 AASHTO T315-20 (Verified)
DIME Test ID: 2022-06-21-58-2 AASHTO T315-20 (Verified)
DIME Test ID: 2022-06-21-58-3 AASHTO T315-20 (Verified)
DIME Test ID: 2022-06-21-58-4 AASHTO T313-19 (Verified)