Sample Taken Date	02/28/2024	Sample Unique Key	25
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	02/28/2024
Sample type	Aggregate Prequalification Program	A brief description of the sample	Washed Concrete Sand
The quantity of what the sample constitutes	100 lbs	From where was the sample collected	Manufacturer
First name of sampler or witnessed by	Ron	Last name of sampler or witnessed by	Novak
Title of sampler		Telephone number of sampler
Laboratory sample identification	24-0052	Linked DIME Sample ID	2024-02-28-16
The fabricator/manufacturer/facility name	CEMEX Cache Creek Aggregates 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)	91-57-0008
The fabricator's/manufacturer's product name for the sample	Washed Concrete Sand	The fabricator/manufacturer designation for the sample
The plant number		A detailed description of where the material sample was collected	Stockpile @ Plant
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	fine
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number

DIME Test ID: 2024-02-28-25-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2024-02-28-25-2 CTM 213-December 2012 (Verified)
DIME Test ID: 2024-02-28-25-4 CTM 217-June 2011 (Verified)
DIME Test ID: 2024-02-28-25-5 CTM 229-June 2011 (Verified)