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: 2015-11-07-6
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:
Soil
FOR USE IN:
Unknown
SAMPLE FROM:
Rte 58 PM 30 point 1 Sta 1405 00
DEPTH:
LOCATION OF SOURCE:
NA
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
NA
DATE NEEDED
TEST RESULTS DESIRED
NORMAL PRIORITY
NORMAL PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
11/07/2015
BY:
Kennedy EuBany
TITLE:
Tester (Unknown)
DIST, CO, RTE, PM:
08-SBD-58-R22.2/R31.1
CONT. NO.:
DEA: 08043514
FED. NO.:
LIMITS:
HINKLEY ROAD FROM 2.4 MILES WEST OF HIDDEN RIVER R
RECIPIENT(S):
(to be selected by data publishing engineer)
CONTRACTOR:
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