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: 2017-04-03-10
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:
Bin #1 1/2 inch untreated (Dispute Resolution)
FOR USE IN:
Unknown
SAMPLE FROM:
Plant
DEPTH:
LOCATION OF SOURCE:
91-10-0006::AVENAL AGGREGATES
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
91-10-0006::AVENAL AGGREGATES
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
04/03/2017
BY:
SPM Avenal
TITLE:
NA (805-473-3016)
DIST, CO, RTE, PM:
06-FRE-33-24.3/R29.0,R39.9/44.5
CONT. NO.:
DEA: 060W7004
FED. NO.:
LIMITS:
FRESNO COUNTY ABOUT 7.8 MILES NORTH OF COALINGA FR
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
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