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: 2017-03-16-3
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:
PIER FOUNDATION
FOR USE IN:
0 TO 15 FT
SAMPLE FROM:
RC-17-3749

DEPTH:
LOCATION OF SOURCE:
NA

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
NA
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
03/16/2017
BY: NICOLA BERNARD
TITLE:
Unknown (Unknown)
DIST, CO, RTE, PM:
11-SD-905,125,905-9.6/11.4
CONT. NO.: DEA: 11288824
FED. NO.:
LIMITS:
SAN DIEGO COUNTY IN AND NEAR SAN DIEGO AT ROUTE 11
RECIPIENT(S): (to be selected by data publishing engineer)
CONTRACTOR:

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