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: 2025-07-23-106
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 bag of Soil
FOR USE IN:
SAMPLE FROM:
Field No BR-SHI, 02-TRI-299-11.4, from embankment - cut slope East of School House Rd, 0–12" depth
DEPTH:
LOCATION OF SOURCE:
In Situ
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
In Situ
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
07/23/2025
BY:
Scott Lewis
TITLE:
Senior Engineering Geologist ((530) 604-3182)
DIST, CO, RTE, PM:
02-TRI-299-8.3/15
CONT. NO.:
DEA: 020J5304
FED. NO.:
LIMITS:
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
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