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180 BLUE RAVINE ROAD, SUITE B <br /> l t FOLSOM, CA 95630-4719 T <br /> AIR TOXICS LTD. (916) 985-1000 FAX: (916) 985-1020, <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY <br /> 02064 <br /> CHAIN— F-CJSTUDY RECORD wage _1 of _ <br /> Contact Person � Inlb VI.�TtIC K ( Project into: Turn Around Time: <br /> Company g17oLU� � c. 4 k1G Ct- <br /> P.O. # 3 I <br /> Address�� City State Zip 27 Project# Formal <br /> Phone cit 6�` yZI`l- O 11-3 El Rush <br /> P <br /> FAX - !QProject Name 9ACv 3� Specify <br /> I Field Sample I.D. Date &Time Analyses Requested Canister Pressure Vacuum <br /> Initial Final Receipt <br /> It E FFt- r 1-3-� Y 41 -T p#( �T 'X <br /> Il-31-1Y 16ZS T-P Nr f3 TE x <br /> r : ------------------- <br /> Collected By: Print signature <br /> (Votes: <br /> oure)Rel(rl e Oat tme Received By:( ' natur ) a un <br /> -y�y �2Sd <br /> Refinq ' hed By'(5 re) Datarru-M Received By:(Signature) Date/Ttme <br /> Relinquished ay:(Signature) Datelrane R ived – <br /> azure] te/rune <br /> f y <br /> Sht t .art► ;:«.. . . r .mss € .r. .::` Data,RimB.: ;_siYi (°C ` Conditiat;. :. Custody Seals IntacWork Order# <br /> IAMD} : ,. <br /> &B 6- ))-) Yes No Non <br /> x <br /> h', Form 1293 rev.05 <br />