Sample Taken Date	07/13/2023	Sample Unique Key	12
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	07/14/2023
Sample type	Acceptance	A brief description of the sample	ISR-RSC Beams
The quantity of what the sample constitutes	15 CY	From where was the sample collected	Job Site
First name of sampler or witnessed by	Neale	Last name of sampler or witnessed by	Brown
Title of sampler	Materials Tester	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	CTS SHORT LOAD RAPID SET	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Concrete	The concrete mix design number	CTS-65-GBR
The truck number from where the sample was collected	15	The batch plant ticket number from where the sample was collected	3
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	Back of truck discharge chute	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2023-07-13-12-1 CTM 504-June 2010 (Verified)
DIME Test ID: 2023-07-13-12-2 CTM 533-June 2010 (Verified)
DIME Test ID: 2023-07-13-12-3 CTM 557-June 2020 (Verified)
DIME Test ID: 2023-07-13-12-4 CTM 524-March 2013 (Verified)