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: 2014-05-23-8000567
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 subgrade.
FOR USE IN:
SAMPLE FROM:
S/B I-710 Cesar Chavez on ramp Sta. 315 00.
DEPTH:
LOCATION OF SOURCE:
S/B I-710 Cesar Chavez on ramp Sta. 315 00.
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
S/B I-710 Cesar Chavez on ramp Sta. 315 00.
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
05/23/2014
BY:
Ben Ehsani
TITLE:
A.R.E. ((490) 413-5060)
DIST, CO, RTE, PM:
07-LA-710-17.2/26.4
CONT. NO.:
DEA: 07202114
FED. NO.:
LIMITS:
LOS ANGELES COUNTY ON ROUTE 710 AT VARIOUS LOCATIO
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
To edit data on this form, you must be logged in to DIME and have sufficient privileges to edit the sample information.