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: 2020-10-29-10
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:
L1 SL6 and L2 SL6
FOR USE IN:
SAMPLE FROM:
na

DEPTH:
LOCATION OF SOURCE:
na

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
na
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
10/29/2020
BY: na na
TITLE:
DIST, CO, RTE, PM:
06-FRE-33-47.4/53.4,72.8/77.6
CONT. NO.: DEA: 060W7104
FED. NO.:
LIMITS:
FRESNO COUNTY NEAR MENDOTA AND FIREBAUGH FROM MOUN
RECIPIENT(S):
CONTRACTOR:
PAPICH CONSTRUCTION CO., INC.

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