Sample Taken Date	08/10/2022	Sample Unique Key	86
Will the laboratory/organization for which you are a member perform testing on this material sample?	No	Date that the sample was received by the laboratory/organization performing the testing	08/11/2022
Sample type	Quality Assurance	A brief description of the sample	LCB
The quantity of what the sample constitutes	70CY	From where was the sample collected	Distributor
First name of sampler or witnessed by	luis	Last name of sampler or witnessed by	acosta
Title of sampler	tet	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	roberton's gardena	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)	91-33-0008
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	belt
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	1 inch
The concrete mix design number	sc270n31	Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2022-08-10-86-1 CTM 226-July 2010 (Verified)
DIME Test ID: 2022-08-10-86-2 CTM 217-June 2011 (Verified)
DIME Test ID: 2022-08-10-86-3 CTM 202-November 2011 (Verified)
DIME Test ID: 2022-08-10-86-4 CTM 202-November 2011 (Verified)