Sample Identification Card TL-0101
You may optionally email a link to the detail page for this sample to project or other relevant personnel. For better printouts, please be sure to print the form using landscape orientation and 100% paper size.
STATE OF CALIFORNIA ● DEPARTMENT OF TRANSPORTATION
SAMPLE IDENTIFICATION CARD
TL-0101 (REV. 02/17)
DIME Sample ID: 2022-03-18-37
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 x 4 PCC Aggregate
FOR USE IN:
SAMPLE FROM:
Belt
DEPTH:
LOCATION OF SOURCE:
90-1.02C
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
90-1.02C
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
03/18/2022
BY:
Pedro De Haro
TITLE:
DIST, CO, RTE, PM:
04-SOL-80-1.8/4.4
CONT. NO.:
DEA: 040J7104
FED. NO.:
LIMITS:
SOLANO COUNTY IN VALLEJO AT VARIOUS LOCATIONS
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
To edit data on this form, you must be logged in to DIME and have sufficient privileges to edit the sample information.