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:2021-09-09-3
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:
ASTM A706 GR 60 Welded Hoops
FOR USE IN:
SAMPLE FROM:
Fabricator

DEPTH:
LOCATION OF SOURCE:
TNT Rebar

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
TNT Rebar
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
09/09/2021
BY: Arthur Peterson
TITLE:
QAI (7073428602)
DIST, CO, RTE, PM:
04-ALA-80-6.4-6.6
CONT. NO.: DEA: 040A7714
FED. NO.:
LIMITS:
ALAMEDA COUNTY IN BERKELEY FROM 0.6 MILE NORTH OF
RECIPIENT(S): LA.METS.Reports@dot.ca.gov;arthur.peterson@dot.ca.gov;jason.trinh@dot.ca.gov;eric.urmeneta@dot.ca.gov;dylan.larose@dot.ca.gov
CONTRACTOR:
Golden State Bridge

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