Sample Taken Date	10/03/2023	Sample Unique Key	103
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	10/04/2023
Sample type	Acceptance	A brief description of the sample	Concrete beams
The quantity of what the sample constitutes	2 Beams	From where was the sample collected	Job Site
First name of sampler or witnessed by	K. Patel /	Last name of sampler or witnessed by	C. Ozuruigbo
Title of sampler	TET	Telephone number of sampler
Laboratory sample identification	2H-A1, 2H-A2	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Robertson's Ready Mix - Adelanto	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	RRM22127
The truck number from where the sample was collected		The batch plant ticket number from where the sample was collected	7951770
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	back of concrete truck	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2023-10-03-103-1 CTM 504-June 2010 (Verified)
DIME Test ID: 2023-10-03-103-2 CTM 518-June 2010 (Verified)
DIME Test ID: 2023-10-03-103-3 CTM 523-May 2020 (Verified)
DIME Test ID: 2023-10-03-103-4 CTM 533-June 2010 (Verified)