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: 2022-02-14-38
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:
3/4 hma core
FOR USE IN:
SAMPLE FROM:
Job Site
DEPTH:
LOCATION OF SOURCE:
Lane Security Paving Joint Venture
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
Lane Security Paving Joint Venture
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
02/14/2022
BY:
Larry Francisco
TITLE:
TE ()
DIST, CO, RTE, PM:
08-SBD-10-0.0/13.2
CONT. NO.:
DEA: 080C2514
FED. NO.:
LIMITS:
LA/SBD County Line to PM 13.2 near I-15
RECIPIENT(S):
michael.kopenski@dot.ca.gov;kenneth.l.varela@dot.ca.gov;LA.METS.Reports@dot.ca.gov;william.clifford@dot.ca.gov;kaushalkumar.talati@dot.ca.gov;vicente.bunyi@dot.ca.gov;shaine.shahidi@dot.ca.gov;joshua.gallaway@dot.ca.gov;michael.cattabiani@dot.ca.gov;nicholas.hoffmann@dot.ca.gov;lguerrero@axiomes.net;mantonelli@i-10express.com;fzahlout@syrusaengineering.com;scott.bauer@dot.ca.gov
CONTRACTOR:
Lane-Security Paving Joint Venture
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