Sample Taken Date	04/26/2023	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	04/27/2023
Sample type	Acceptance	A brief description of the sample	6X12 PCC cylinder
The quantity of what the sample constitutes	130 CY	From where was the sample collected	Job Site
First name of sampler or witnessed by	Daniel	Last name of sampler or witnessed by	Meza
Title of sampler	Assistant Structure Representative	Telephone number of sampler
Laboratory sample identification	23-094	Linked DIME Sample ID
The fabricator/manufacturer/facility name	National Ready Mix Concrete Company	Transportation Laboratory (TL) Number	230426
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name	Junction Structure

Material Type	Concrete	The concrete mix design number	S563300
The truck number from where the sample was collected	Load 1	The batch plant ticket number from where the sample was collected	554709
Concrete batch plant	National Ready Mix Concrete	The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	truck chute	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2023-04-26-55-1 CTM 521-June 2020 (Verified)
DIME Test ID: 2023-04-26-55-2 CTM 521-June 2020 (Verified)
DIME Test ID: 2023-04-26-55-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2023-04-26-55-4 CTM 521-June 2020 (Verified)