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:2020-11-03-12
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:
(no information entered)
SAMPLE FROM:
5 feet depth

DEPTH:
LOCATION OF SOURCE:
Caltrans

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Caltrans
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
11/03/2020
BY: Justin Anderson
TITLE:
Transportation Engineer (925-989-0909)
DIST, CO, RTE, PM:
04-SCL-4-SCl-9 -4.75/4.9
CONT. NO.: DEA: 043G6304
FED. NO.:
LIMITS:
San Jose - Saratoga Creek
RECIPIENT(S):
CONTRACTOR:
Myers and Sons

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