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0 9 0 <br /> AIR TOXICS LTD. 180 BLUE RAVINE ROAD, SUITE B . <br /> ANENVIRONMENTAL ANALYTICAL LABORATORY FOLSOM, CA 95630-4719(916) 985-1000 FAX (916) 985-1020 <br /> CHAIN-OF-CUSTODY RECORD 1 ' i' ' i <br /> Page —_ of <br /> Contact Person Project info Turn Around Time <br /> Company U Id PO # �?e f CL' <br /> Address [Normal <br /> Ity C Statea Zip ��7 Project # -2 ' <br /> El Rush <br /> Phone Ll q O/ FAX Project Name C � "i Specify <br /> Collected By signature 4ti�LL <br /> Lab <br /> I Field Sample I D Date & Time Analyses Requested <br /> Canister Pressure / Vacuum <br /> Initial Final Receipt <br /> t c ` <br /> Rshed B ( ature} ima /dj 3d Print Name Notes <br /> Relinquished By ature) pal Received By(Signature) 15atatTirne <br /> Relinquish Syr(Signature} DatefCene Received By atur Dat a <br /> u ATC. 16 30 <br /> Shi er Name Air BID# nett B ate/Time Temp (°C) Condttto Custody Seals Intact) Work Order# <br /> Lab `�-'�� 'q <br /> Use ` `^'t tt�l t� � (U� rII� t i`� (��� 7 Yes No None r /A <br /> Only _ 9-5-0-4-0-3-6 <br /> Forrn IM rev 06 <br />