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:2019-09-09-7
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:
Agg Subbase
FOR USE IN:
Unknown
SAMPLE FROM:
I-15 SB PM 34.7 to 51.6

DEPTH:
LOCATION OF SOURCE:
Unknown

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Unknown
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
09/09/2019
BY: Unknown Unknown
TITLE:
()
DIST, CO, RTE, PM:
08-RIV-15-34.7/51.6
CONT. NO.: DEA: 080J0804
FED. NO.:
LIMITS:
Riverside County and SBD-15-0.0/1.3
RECIPIENT(S):
CONTRACTOR:
Skanska-Ames, Joint Venture

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