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: 2020-03-11-26
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:
Soil
FOR USE IN:
Unknown
SAMPLE FROM:
02-TRI-3-32.81, at DI, 6 inch Depth

DEPTH:
LOCATION OF SOURCE:
In Situ

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
In Situ
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
03/11/2020
BY: Dan Curran
TITLE:
DIST, CO, RTE, PM:
02-TRI-3-30.4/T57.9
CONT. NO.: DEA: 020H5404
FED. NO.:
LIMITS:
VARIOUS LOCATIONS FROM 0.5 MILE SOUTH OF TRINITY R
RECIPIENT(S):
CONTRACTOR:

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