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: 2024-09-05-91
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:
1 gallon can
FOR USE IN:
SAMPLE FROM:
Other
DEPTH:
LOCATION OF SOURCE:
KBP
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
KBP
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
09/05/2024
BY:
Joel Gosik
TITLE:
RE ()
DIST, CO, RTE, PM:
02-TEH,TEH/TEH,PLU/PLU,LAS/LAS,SHA/SHA,PLU,LAS,TEH,SHA-32,36,44,189,147,172-0/24.87, 43.95/104, 0/18.42, 0/6, 14.3/19.2, 19.01/71.39, 0/37.25, 8.9/42.3, 0/9.89, 0/1.8, 0/8.92, 0/4.4, 43.95/19.2, 62.69/37.25, 19.01/62.69, 0/21.72, 6/14.3, 0/247.87, 83/19.2
CONT. NO.:
DEA: 023J2204
FED. NO.:
LIMITS:
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
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