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:2020-12-30-1
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:
#11 HRC 500/510 Coupler
FOR USE IN:
SAMPLE FROM:
Source

DEPTH:
LOCATION OF SOURCE:
CMC San Bernardino

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
CMC San Bernardino
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
12/30/2020
BY: Michael Cattabiani
TITLE:
(2016746612)
DIST, CO, RTE, PM:
11-SD-5-R37.4 - R46.5
CONT. NO.: DEA: 112T2174
FED. NO.:
LIMITS:
IN SAN DIEGO COUNTY IN SOLANA BEACH AND ENCINITAS
RECIPIENT(S): kenneth.l.varela@dot.ca.gov;LA.METS.Reports@dot.ca.gov;raymond.aludino@dot.ca.gov;steve.mcmillan@dot.ca.gov;adrian.cortez@dot.ca.gov;michael.cattabiani@dot.ca.gov;phong.t.le@dot.ca.gov;scott.bauer@dot.ca.gov
CONTRACTOR:
Flatiron-Skanska-Stacy and Witbeck, a Joint Venture

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