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180 BLUE RAVINE* ROAD, SUITE B <br /> AIR TOXICS LTD, FOLSOM, CA 95630-4719 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985-1000 FAX: (916) 985-1020 <br /> ifl �t <br /> CHAIN-OF-CUSTODY RECORD Page of <br /> Contact Person M l0D-- "tTf!250AJ Project info: <br /> Company TI?� Ado L-DU1t - <br /> + L 1 Turn Around Time: <br /> ���� P.O. # � .3 I � orrnal <br /> Address g b 1 c m i eft" *�yo City _State L Zip 7 Project# <br /> 9�b- t�Ny_o,Z ❑ Rush <br /> Phone FAX 91 —�S6 S 7 Project Name A r7r U y 3 specify <br /> pb Field Sample I.D. Date 8 Time Analyses Requested <br /> Canister Pressure/Vacuum <br /> Initial Final Receipt <br /> F��L 9y 135 T <br /> y 13 315 <br /> r� <br /> t <br /> Collected B Print signature Notes: <br /> Relinquish Received By:(Signature)7D <br /> lZr-'�Irtl -?-IfIS~30 <br /> Relinquished BSr(Signatu ) une Received By:(Signature) Date/Time <br /> Relinquished%r(Signature) Date/Tane lure) leIr" ( � <br /> atter.:; t .o. "- Imo: {t..'fi x`" 8d DaX "U1 <br /> ..[t1 {°C . Canddlan`.` ,Cosi ;Seals lntacf o k rd r# <br /> r <br /> t #:8? 11110 D 97Lt.�-sJlrrZfio '+. `.. .�ed ism Yes No NonQ. <br /> i <br /> { <br /> • . I <br /> V - 1293 rev.05 <br />