Sample Identification Card TL-0101

You may optionally email a link to the detail page for this sample to project or other relevant personnel. For better printouts, please be sure to print the form using landscape orientation and 100% paper size.

×
STATE OF CALIFORNIA ● DEPARTMENT OF TRANSPORTATION
SAMPLE IDENTIFICATION CARD
TL-0101 (REV. 02/17)
DIME Sample ID:2013-12-06-7000585
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:
Class 2 Aggregate Base
FOR USE IN:
SAMPLE FROM:
E/B 91 Sta. 324 50

DEPTH:
LOCATION OF SOURCE:
Unknown

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Unknown
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
12/06/2013
BY: Kohnson Chan
TITLE:
()
DIST, CO, RTE, PM:
08-RIV-91-15.6/21.6
CONT. NO.: DEA: 08448404
FED. NO.:
LIMITS:
RIVERSIDE COUNTY IN RIVERSIDE FROM ADAMS STREET TO
RECIPIENT(S):
CONTRACTOR:
SEMA CONSTRUCTION INC

To edit data on this form, you must be logged in to DIME and have sufficient privileges to edit the sample information.