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:2020-11-20-2
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:
Lot 1 and 2 #8 x 3'-11" dia hoops
FOR USE IN:
SAMPLE FROM:
Fabricator

DEPTH:
LOCATION OF SOURCE:
RKR Steel Welding

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
RKR Steel Welding
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
11/20/2020
BY: Steve Hall
TITLE:
(6466327821)
DIST, CO, RTE, PM:
11-SD-11,125,905-Various
CONT. NO.: DEA: 112888U4
FED. NO.:
LIMITS:
SAN DIEGO COUNTY AT VARIOUS LOCATIONS
RECIPIENT(S): kenneth.l.varela@dot.ca.gov;LA.METS.Reports@dot.ca.gov;steven.hall@dot.ca.gov;Raymond.Aludino@dot.ca.gov;carlos.covarrubias@dot.ca.gov;nikki.tiongco@dot.ca.gov;venkatesh.iyer@dot.ca.gov
CONTRACTOR:
Skanska USA Civil West CA

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