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:2020-12-01-16
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:
East Side of I-5 at PM 44.48, At Surface at Outlet

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:
12/01/2020
BY: E Easterling
TITLE:
Transportation Engineer ()
DIST, CO, RTE, PM:
06-FRE-5-37.2/48.8
CONT. NO.: DEA: 060X2704
FED. NO.:
LIMITS:
from 1.9 miles north of Three Rocks Road UC to 0.2
RECIPIENT(S): nathan.strid@dot.ca.gov
CONTRACTOR:

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