Sample Taken Date	05/20/2024	Sample Unique Key	121
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	05/20/2024
Sample type	Aggregate Prequalification Program	A brief description of the sample	Washed Concrete Sand
The quantity of what the sample constitutes	2 bags	From where was the sample collected	Source
First name of sampler or witnessed by	Dylan	Last name of sampler or witnessed by	Cardoza
Title of sampler	QC Technician	Telephone number of sampler	559-598-3019
Laboratory sample identification		Linked DIME Sample ID	2024-05-20-82
The fabricator/manufacturer/facility name	Cemex Rockfield	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)	91-10-0014
The fabricator's/manufacturer's product name for the sample		The fabricator/manufacturer designation for the sample
The plant number	4401	A detailed description of where the material sample was collected	Loader mixed sample stockpile
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: 2024-05-20-121-1 CTM 202-November 2011 (Verified)
DIME Test ID: 2024-05-20-121-2 CTM 213-December 2012 (Verified)
DIME Test ID: 2024-05-20-121-4 CTM 217-June 2011 (Verified)
DIME Test ID: 2024-05-20-121-5 CTM 229-June 2011 (Verified)