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Sample Transportation Notice <br /> Air Relinquishing signature on thsdccument indicates that sample is being shipped in compliance wit <br /> h 180BLUE RAVINE ROAD,SUITE B <br /> all applicable local,State,Federal,national,and international laws,regulations and ordinances of FOLSOM,CA 95630-4719 <br /> ton,handling or shipping <br /> gToxh'i LTD. any kind.Air-roxics Limited assumes no liability with respect to the collection, (916)985-1000 FAX(916)985-1020 <br /> of these samples. Relinquishing signature also indicates agreement to hold harmless, defend, <br /> CHAIN-OF-CUSTODY RECORD and indemnify Air Toxics Limited against any calm,demand,or action,of any kind,related to the Page—of— <br /> collection,handling,or shipping of samples.D.O.T.Hotline(800)467-4922 <br /> Turn Around Lab use Only <br /> Project Marl Project Info: Time: Pressurized by: <br /> Collected by:(Print and Sign) P.o.# �Alormal Date: <br /> m I k' <br /> Company Email tl'�Q e it e) Rush <br /> k Pressurization Gas: <br /> Address Arlv�i*.:-k city 5cLZ^111-3 State_!f�k 7-p 0 1 Project 0 <br /> Project Name Specify <br /> Phone Fax —C�ft-- W-:714 61k+4 LLC— N, He <br /> Canister Pressure/Vacuum <br /> Date Time <br /> of Collection <br /> Lab I.D. Field Sample I.D.(Location) Can# of Collection of Collection Analyses Requested Initial Final Receipt I Final <br /> (P <br /> C) <br /> V 10 �1-% <br /> it <br /> -346 SaA 02-69%'2 0 1 fjz'P <br /> w, <br /> -751 'PvW 3�,725�� <br /> IJ.4 30 <br /> g me Notes: CF�c <br /> Relinquished DateMme peen W D terri <br /> d by:(signature) -1 )ved Received c;-- <br /> (,-,e- 0210t <br /> Relinquished by:(signature) DateMme Received by:(signature) Daterrinird J av <br /> Relinquished by:(signature) Date/Time Received by:(signature) DateMme <br /> Lab Shipper Name Air Bill # Temp ('C) Condition Custody Seals Intact? Work Order# <br /> N 0 <br /> 0 ' <br /> Use IN Yes one L) <br /> Only <br /> 6. Form 1293 mll <br />