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: 2016-07-26-7
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:
One inch PCC Aggregates
FOR USE IN:
Unknown
SAMPLE FROM:
Robertsons Stockpiles

DEPTH:
LOCATION OF SOURCE:
SMARA 91 33 0008

SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
AND IS ONE OF A GROUP OF
THIS SAMPLE IS SHIPPED IN(NO. CONTAINERS)
OWNER OR MANUFACTURER:
SMARA 91 33 0008
DATE NEEDED
TEST RESULTS DESIRED
NORMAL   PRIORITY
TOTAL QUANTITY AVAILABLE
REMARKS:
DATE SAMPLED:
07/26/2016
BY: Unknown Unknown
TITLE:
Unknown (Unknown)
DIST, CO, RTE, PM:
08-RIV-60-R12.2/22.1&26.5/30.4
CONT. NO.: DEA: 081C0914
FED. NO.:
LIMITS:
MILL AND OVERLAY MAINLINE PAVEMENT, SHOULDERS, RAM
RECIPIENT(S):
CONTRACTOR:
ALL AMERICAN ASPHALT

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