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: 2020-06-24-2
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:
#6 x 5'-2" Dia.
FOR USE IN:
SAMPLE FROM:
Fabricator

DEPTH:
LOCATION OF SOURCE:
TNT Rebar

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
TNT Rebar
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
06/24/2020
BY: Osiel Ramirez
TITLE:
CT METS QA INSPECTOR (5599740870)
DIST, CO, RTE, PM:
02-TRI-36-26.7/27.1
CONT. NO.: DEA: 024F8604
FED. NO.:
LIMITS:
TRINITY COUNTY ABOUT 9 MILES EAST OF FOREST GLEN F
RECIPIENT(S): Osiel.Ramirez@dot.ca.gov;LA.METS.Reports@dot.ca.gov;mike.sears@dot.ca.gov;peter.gan@dot.ca.gov
CONTRACTOR:
Steelhead Constructors

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