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:2019-06-25-24
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:
3/4 RHMA-G-SP
FOR USE IN:
Unknown
SAMPLE FROM:
Unknown

DEPTH:
LOCATION OF SOURCE:
91-33-0005::ALL AMERICAN ASPHALT

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
91-33-0005::ALL AMERICAN ASPHALT
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
06/25/2019
BY: Loi Nguyen
TITLE:
()
DIST, CO, RTE, PM:
07-LA-110-R0.7/24.1
CONT. NO.: DEA: 073009U4
FED. NO.:
LIMITS:
LOS ANGELES COUNTY IN AND NEAR LOS ANGELES AND CAR
RECIPIENT(S):
CONTRACTOR:
All American Asphalt

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