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:2014-06-01-9208998
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:
SAMPLE FROM:
PM 22.1 N/B Lane 5

DEPTH:
LOCATION OF SOURCE:
PM 22.1 N/B Lane 5

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
PM 22.1 N/B Lane 5
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
06/01/2014
BY: Unknown Unknown
TITLE:
()
DIST, CO, RTE, PM:
08-SBD-15-15.4/30.8
CONT. NO.: DEA: 080Q7403
FED. NO.:
LIMITS:
On I-15 from 0.4 mile north of Kenwood Avenue to 0
RECIPIENT(S):
CONTRACTOR:
Coffman Specialties, Inc./Parsons Transportation Group, Inc

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