Sample Taken Date	09/28/2022	Sample Unique Key	3
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	09/28/2022
Sample type	Acceptance	A brief description of the sample	Type 2 AB
The quantity of what the sample constitutes	14 CY	From where was the sample collected	Supplier
First name of sampler or witnessed by	Salvador	Last name of sampler or witnessed by	Lopez-zamora
Title of sampler		Telephone number of sampler	8057483854
Laboratory sample identification	220928A	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Calportland-Garey	Transportation Laboratory (TL) Number
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)	91-42-0014
The fabricator's/manufacturer's product name for the sample	Class 2 aggregate base	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	stockpile at calportland
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: 2022-09-28-3-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-09-28-3-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-09-28-3-3 CTM 229-June 2011 (Verified)
DIME Test ID: 2022-09-28-3-4 CTM 229-June 2011 (Verified)