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: 2020-06-04-35
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:
PG 58-34 M, #20 Test, #15 (037394), #16 (037393), #17(037395), #18(037396), #19(037399), #21(037400), #22(851352), #23(851353), #24(851354), #25(851356)
FOR USE IN:
SAMPLE FROM:
Source
DEPTH:
LOCATION OF SOURCE:
Valero - Benicia, CA
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Valero - Benicia, CA
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
06/04/2020
BY:
Dorell Harper
TITLE:
consultant ()
DIST, CO, RTE, PM:
02-TRI-3-32.0/38.0,53.7/63.8
CONT. NO.:
DEA: 024H2404
FED. NO.:
LIMITS:
TRINITY COUNTY NEAR WEAVERVILLE FROM 0.4 MILE NORT
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
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