Sample Taken Date	08/30/2022	Sample Unique Key	83
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	08/31/2022
Sample type	Acceptance	A brief description of the sample	2 bags of 3/4-inch Maximum Class 2 Aggregate Base
The quantity of what the sample constitutes	500 – 2000 cy	From where was the sample collected	Job Site
First name of sampler or witnessed by	Trina	Last name of sampler or witnessed by	Wiliams
Title of sampler	ARE	Telephone number of sampler
Laboratory sample identification	D79148	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Custom Crushing	Transportation Laboratory (TL) Number	891186
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	Custom Crushing
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Windrow, after blade passed
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	3/4 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Test ID: 2022-08-30-83-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-08-30-83-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-08-30-83-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2022-08-30-83-4 CTM 301-March 2000 (Verified)