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:2019-02-14-2
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:
UBS Hoops
FOR USE IN:
SAMPLE FROM:
Fabricator

DEPTH:
LOCATION OF SOURCE:
TNT Rebar

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
TNT Rebar
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
02/14/2019
BY: David Weeks
TITLE:
QA (310-883-8369)
DIST, CO, RTE, PM:
06-FRE-269-10.6/12.4
CONT. NO.: DEA: 06394604
FED. NO.:
LIMITS:
FRESNO COUNTY NEAR HURON FROM 1.0 MILE NORTH OF PA
RECIPIENT(S): david.weeks@dot.ca.gov;kenneth.l.varela@dot.ca.gov;LA.METS.Reports@dot.ca.gov;din.dadawalla@dot.ca.gov;nathan.quiroz@dot.ca.gov;todd.smith@dot.ca.gov
CONTRACTOR:
A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION

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