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: 2019-11-06-25
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:
SOIL
FOR USE IN:
Unknown
SAMPLE FROM:
08-SBD-15-PM110 SURFACE
DEPTH:
LOCATION OF SOURCE:
NATIVE
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
NATIVE
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
11/06/2019
BY:
HAKIMA H
TITLE:
TE CIVIL (562-665-0454)
DIST, CO, RTE, PM:
08-SBD-15-R110.0
CONT. NO.:
DEA: 081G7404
FED. NO.:
LIMITS:
BETWEEN BARSTOW AND BAKER AT 1.6 MILES SOUTH OF AF
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
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