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180 BLUE RAVINE ROAD, SUITE B <br /> AIR TOXICS LTD. FOLSOM, CA 95630-4719 <br /> @ 1)2 ri 6 <br /> (916) 985-1000 FAX: (916) 985-1020 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY <br /> CHAIN-OF-CUSTODY RECORD Page —i- Of _ <br /> Contact Person M IN DY <br /> Project info: Turn Around Time: <br /> Companyyi?Lpt.y&l j <br /> P.O. # j.3 � ormal <br /> Address 11PI C FYI' City State Zip 7 Project# <br /> O Rush <br /> Phone 9i6' y y' t Z FAX 9�6 $S6 —S Z-7 Project Name U y 3 Specify <br /> Field Sample I.D. Date & Time Requested Analyses Re Canister Pressure /Vacuum <br /> ' y q Initial Final Receipt <br /> cc7FF4— t 9y 13;Z T i <br /> I n/FL ' 9 y 13 3 7'�f�� 7Z`X <br /> Collected B PrintLop Signature Notes: <br /> Relinquishe • S' 1pe Received By:(Signature) 0 e <br /> /z-9 9Y /SAO <br /> Relinquished :(Sw-atu e) a une Received By.(Signature) Date/Time <br /> s <br /> Relinquished By:(Signature) Date/nme ceiv nature) ate/f <br /> Shi r;Namet erred t3 Data1`t ma Telop. °C Condition Custody Seals intact? o k rd r# <br /> .. <br /> Yes Nc NonQ .r <br /> Form 1293 rev.05 <br />