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: 2019-06-11-12
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:
ASTM F1554 Gr 55 Anchor Bolt
FOR USE IN:
SAMPLE FROM:
Manufacturer

DEPTH:
LOCATION OF SOURCE:
Nucor

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Nucor
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
06/11/2019
BY: Chris Dsousa
TITLE:
DIST, CO, RTE, PM:
07-LA-10-33.2/37.2
CONT. NO.: DEA: 071170U4
FED. NO.:
LIMITS:
LOS ANGELES COUNTY IN BALDWIN PARK AND WEST COVINA
RECIPIENT(S): lisandro.gomez@dot.ca.gov;Kenicia.lemos@dot.ca.gov;micheal.chou@dot.ca.gov;ryan.ramos@dot.ca.gov;oscar.r.rodriguez@dot.ca.gov;raj.punjabi@dot.ca.gov;jennifer.man@dot.ca.gov;james.devey@prescienceengineers.com;hitesh.h.patel@dot.ca.gov;venkatesh.iyer@amecfw.com
CONTRACTOR:
Ames Construction, inc.

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