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:2018-11-15-7
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:
Couplers
FOR USE IN:
SAMPLE FROM:
Job Site

DEPTH:
LOCATION OF SOURCE:
Gerdau, HRC

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Gerdau, HRC
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
11/15/2018
BY: Abbas Iranmanesh
TITLE:
Unknown (Unknown)
DIST, CO, RTE, PM:
04-SM-1-R44.1
CONT. NO.: DEA: 044G8504
FED. NO.:
LIMITS:
SAN MATEO COUNTY IN PACIFICA AT THE SAN JOSE AVENU
RECIPIENT(S): elaine.yip@dot.ca.gov;jason.m.gramlick@dot.ca.gov;jose.david@dot.ca.gov;jason.louie@dot.ca.gov;maged.g.armanuse@dot.ca.gov
CONTRACTOR:
BRIDGEWAY CIVIL CONSTRUCTORS, INC.

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