Sample Identification Card TL-101
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SAMPLE IDENTIFICATION CARD
TL-0101 (REV. 10/12)
TL-0101 (REV. 10/12)
SAMPLE NUMBER:
TEST TYPE:
DIST. LAB
TRANS. LAB
SAMPLE SENT TO:
HDQRS. LAB
BRANCH LAB
DIST. LAB
FIELD NO.
DIST LAB NO.
LOT NO.
SHIPMENT NO.
P.O. OR REQ. NO.
AUTHORIZATION NO.
SAMPLE OF:
FOR USE IN:
SAMPLE FROM:
DEPTH:
LOCATION OF SOURCE:
THIS SAMPLE IS SHIPPED IN (NO. CONTAINERS)
AND IS ONE OF A GROUP OF
SAMPLES REPRESENTING (TONS, GALS, BBLS, STA, ETC.)
OWNER OR MANUFACTURER:
TOTAL QUANTITY AVAILABLE
TEST RESULTS DESIRED
NORMAL
PRIORITY
DATE NEEDED
REMARKS:
DATE SAMPLE:
BY:
TITLE:
DIST, CO, RTE, PM:
LIMITS:
CONT. NO.:
FED. NO.:
RECIPIENT(S):
CONTRACTOR:
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