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:2021-07-02-5
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:
A706 Grade 60 Rebar
FOR USE IN:
SAMPLE FROM:
Source

DEPTH:
LOCATION OF SOURCE:
Martinez Steel

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Martinez Steel
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
07/02/2021
BY: William Clifford
TITLE:
QA Inspector (7142674733)
DIST, CO, RTE, PM:
03-SAC-50-L0.2/R6.1
CONT. NO.: DEA: 030H08U4
FED. NO.:
LIMITS:
FROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT
RECIPIENT(S): LA.METS.Reports@dot.ca.gov;frederic.aboujaoude@dot.ca.gov;Rodney.Murphy@dot.ca.gov;Kenneth.haas@dot.ca.gov;mihai.hantelmann@dot.ca.gov
CONTRACTOR:
FLATIRON WEST INC

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