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MM M i i i M 9 M ! M M i M M <br /> 180 BLUE RAVINE ROAD, -'WE; <br /> AIR TOXICS LTD. FOLSOM, CA 95630-4719 <br /> (916) 985-1000 FAX (916) 985-1020 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY J <br /> Cx N: 001727 <br /> CHAIN-OF-CUSTODY RECORD Page _ of _ <br /> Contact Person L Yn'i� � �I3rjR�,.r 10A. 1 <br /> Protect Info Turn Around Time * <br /> Company a r'G�< �� �� .� <br /> P O # 4 Normal a -J1Address 3C 3 l�lrr / �� _ ?.� City��.;rrr - /hate'l Zipg ZLZ Project# 11� <br /> Phone 6-77� 3G S=` 5417 --- - El Rush <br /> FAX Project Name Specify <br /> Lab V Ilk <br /> Reid Sample I D Date &Time Analyses Requested <br /> Canister Pressure/Vacuum <br /> _ Initial Final Receipt <br /> 70 <br /> �r <br /> 3 <br /> Collected$y Pnnt Signature <br /> [11c C AIZ-�-, Notes <br /> Relinquished By (signature) Datemme Received By (Signature) Datefrime <br /> L <br /> Relinquished By (Signature) DatiMme---- '�— ---��q�cerved By (Signature) rme <br /> Re6n sh5'g to ) Datemme <br /> eceWdi igt at s -1/'# � <br /> r, <br /> Late Shipper Name Air Bill# Openers B Date/Time Terri (°C) Condition Custody Seals Intact Work Order# <br /> Use Yes No None <br /> Only i <br /> Form 1293 rev 05 <br />