Sample Taken Date	01/12/2024	Sample Unique Key	26
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	01/17/2024
Sample type	Department Acceptance	A brief description of the sample	4X8 PCC cylinders
The quantity of what the sample constitutes	130 CY	From where was the sample collected	Job Site
First name of sampler or witnessed by	Noura	Last name of sampler or witnessed by	Alayyan
Title of sampler	Assistant Structure Representative	Telephone number of sampler
Laboratory sample identification	24-002	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Powell Constructors	Transportation Laboratory (TL) Number	41977818
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Concrete	The concrete mix design number	1610974
The truck number from where the sample was collected	48052	The batch plant ticket number from where the sample was collected	41977815
Concrete batch plant	NA	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: 2024-01-12-26-1 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-01-12-26-2 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-01-12-26-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2024-01-12-26-4 CTM 521-June 2020 (Verified)