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: 2021-09-24-1
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:
#6 - 2'-6" hoops
FOR USE IN:
SAMPLE FROM:
Fabricator

DEPTH:
LOCATION OF SOURCE:
CMC Rebar Etiwanda

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
CMC Rebar Etiwanda
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
09/24/2021
BY: Leslie Guerrero
TITLE:
QAI (4242338040)
DIST, CO, RTE, PM:
05-SB-101-7.3/9.6
CONT. NO.: DEA: 050N73U4
FED. NO.:
LIMITS:
SUMMERLAND FROM 0.2 MILES NORTH OF PARDARO LANE OV
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.