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: 2021-08-24-17
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:
3/8 Inch lime treated Coldfeed
FOR USE IN:
02 Plumas 49
SAMPLE FROM:
Plant

DEPTH:
LOCATION OF SOURCE:
Spanish Springs

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Spanish Springs
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
08/24/2021
BY: J. Delgado
TITLE:
Consultant ()
DIST, CO, RTE, PM:
02-PLU-49-0.0/7.5
CONT. NO.: DEA: 022J0004
FED. NO.:
LIMITS:
PLUMAS COUNTY AT AND NEAR VINTON FROM SIERRA COUNT
RECIPIENT(S): Daniel.Gibbs@dot.ca.gov
CONTRACTOR:
ALL AMERICAN CONSTRUCTION

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