Sample Taken Date	12/12/2022	Sample Unique Key	21
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	12/16/2022
Sample type	Annual Source Testing	A brief description of the sample	1" x No4 PCC
The quantity of what the sample constitutes	10 Bags	From where was the sample collected	Source
First name of sampler or witnessed by	Antonio	Last name of sampler or witnessed by	Fuentes
Title of sampler	QC Technician	Telephone number of sampler	925-406-9947
Laboratory sample identification	Rich_22_4935	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Martin Marietta Clayton Aggregates	Transportation Laboratory (TL) Number	C422-280
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)	91-07-0003
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	source stockpile
Where the material sample would have been placed if not sampled	source	Primary Aggregate Nominal Size	1 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2022-12-12-21-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-12-12-21-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2022-12-12-21-3 CTM 206-October 2011 (Verified)
DIME Test ID: 2022-12-12-21-4 CTM 211-May 2010 (Verified)