Sample Taken Date	02/13/2023	Sample Unique Key	55
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	02/13/2023
Sample type	Department Acceptance	A brief description of the sample	BRIDGE
The quantity of what the sample constitutes	BRIDGE	From where was the sample collected	Job Site
First name of sampler or witnessed by	HARISH	Last name of sampler or witnessed by	Thakur
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	SKID TEST	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Roadway/Bridge Surface	Pavement Surface Type	Not set
Type of Traffic Control Provided	Not set	DIST-CO-RTE	Not set
Direction of Travel	Not set	Post Mile	Not set
Lanes to be Tested	Not set	Station	Not set

DIME Test ID: 2023-02-13-55-1 CTM 342-August 2012 (Verified)
DIME Test ID: 2023-02-13-55-2 CTM 342-August 2012 (Verified)
DIME Test ID: 2023-02-13-55-4 CTM 342-August 2012 (Verified)
DIME Test ID: 2023-02-13-55-5 CTM 342-August 2012 (Verified)