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:2017-08-04-2
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:
6/10 x 270 KSI Strand
FOR USE IN:
SAMPLE FROM:
Manufacturer

DEPTH:
LOCATION OF SOURCE:
Sumiden Wire

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Sumiden Wire
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
08/04/2017
BY: Ramos RAMOS
TITLE:
QA (916-996-2658)
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): gino.del.chiaro@dot.ca.gov;rramos@altavistasolutions.com;james.devey@prescienceengineers.com
CONTRACTOR:
Shimmick/FCC/Impregilo (SFI) JV

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