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:2017-02-09-6
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:
A709 Steel Check Sample
FOR USE IN:
SAMPLE FROM:
Fabricator

DEPTH:
LOCATION OF SOURCE:
Stinger Bridge Iron

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Stinger Bridge Iron
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
02/09/2017
BY: Joe Lanz
TITLE:
Unknown (Unknown)
DIST, CO, RTE, PM:
07-LA-710-6.0-9.4
CONT. NO.: DEA: 07288604
FED. NO.:
LIMITS:
Port of Long Beach (District 7)
RECIPIENT(S): kenneth.l.varela@dot.ca.gov;LA.METS.Reports@dot.ca.gov;michaelemami@caltrop.com;joelanz@caltrop.com;biman.roy@dot.ca.gov
CONTRACTOR:
Shimmick/FCC/Impregilo (SFI) JV

To edit data on this form, you must be logged in to DIME and have sufficient privileges to edit the sample information.