Sample Identification Card TL-0101
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STATE OF CALIFORNIA ● DEPARTMENT OF TRANSPORTATION
SAMPLE IDENTIFICATION CARD
TL-0101 (REV. 02/17)
DIME Sample ID: 2024-09-17-29
FIELD NO.
DIST LAB NO.
LOT NO.
P.O. OR REQ. NO.
TEST TYPE:
SHIPMENT NO.
AUTHORIZATION NO.
SAMPLE SENT TO:
HDQRS. LAB
BRANCH LAB
DIST. LAB
TRANS. LAB
SAMPLE OF:
2 bags of sand, 1 bag of 3/8 pea gravel
FOR USE IN:
Pier 4(left)
SAMPLE FROM:
Sample was taken at the plant
DEPTH:
LOCATION OF SOURCE:
Tidewater Stary Pit
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Tidewater Stary Pit
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
09/17/2024
BY:
Gary Zamora
TITLE:
Transportation Engineer (7076665469)
DIST, CO, RTE, PM:
01-DN-101-35.8/36.5
CONT. NO.:
DEA: 01436404
FED. NO.:
LIMITS:
DR. FINE BRIDGE REPLACEMENT FROM LAKE EARL DR TO S
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
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