Sample Taken Date	05/12/2023	Sample Unique Key	39
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	05/12/2023
Sample type	Aggregate Prequalification Program	A brief description of the sample	3/4" Crushed Aggregate
The quantity of what the sample constitutes	4 bags of aggregate	From where was the sample collected	Source
First name of sampler or witnessed by	Dylan	Last name of sampler or witnessed by	Evans
Title of sampler	QC Technician	Telephone number of sampler
Laboratory sample identification	1950523846	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Granite Felton Quarry	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)	91-44-0003
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	Stockpile sample
Where the material sample would have been placed if not sampled	Use in Felton Hot Plant	Primary Aggregate Nominal Size	3/4 inch
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2023-05-12-39-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2023-05-12-39-2 CTM 227-December 2014 (Verified)
DIME Test ID: 2023-05-12-39-3 CTM 211-May 2010 (Verified)
DIME Test ID: 2023-05-12-39-4 CTM 214-August 2010 (Verified)