Sample Taken Date	04/11/2023	Sample Unique Key	7
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	04/11/2023
Sample type	Acceptance	A brief description of the sample	Class 2 Aggregate Base
The quantity of what the sample constitutes	3 bags of Class 2 AB	From where was the sample collected	Job Site
First name of sampler or witnessed by	Bernard	Last name of sampler or witnessed by	Guinto
Title of sampler	Inspector	Telephone number of sampler	6613324272
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	jobsite Rte 119	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)	91-15-0114
The fabricator's/manufacturer's product name for the sample	Solari Granite	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	windrow at the jobsite
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

DIME Test ID: 2023-04-11-7-1 CTM 217-June 2011 (Verified)
DIME Test ID: 2023-04-11-7-3 CTM 202-November 2011 (Verified)
DIME Test ID: 2023-04-11-7-4 CTM 229-June 2011 (Verified)
DIME Test ID: 2023-04-11-7-5 CTM 202-November 2011 (Verified)