Sample Taken Date	09/21/2022	Sample Unique Key	42
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	09/27/2022
Sample type	Acceptance	A brief description of the sample	PG 76-22M
The quantity of what the sample constitutes	1 Can	From where was the sample collected	Source
First name of sampler or witnessed by	T	Last name of sampler or witnessed by	B
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Valero - Benicia	Transportation Laboratory (TL) Number	864464
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Asphalt Binder	Performance Grade	PG 76-22 M
Modified	Yes	Lot number
Sublot number		Tank number
Time of sample		HMA Supplier
Certified Asphalt Supplier	Valero Marketing & Supply - Benicia CA	Multigrade	No
Multigrade Type		Asphalt Binder Mix Number	Not set

DIME Test ID: 2022-09-21-42-1 AASHTO T315-22 (Verified)
DIME Test ID: 2022-09-21-42-2 AASHTO T315-22 (Verified)
DIME Test ID: 2022-09-21-42-3 AASHTO T315-22 (Verified)
DIME Test ID: 2022-09-21-42-4 AASHTO T313-22 (Verified)