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AIR TOXICS LTD. 180 BLUE RAVINE ROAD, SUITE e <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY FOLSOM, CA 95630-4719(916) 985-1000 FAX (916) 985 1020 <br /> CHAIN-OF-CUSTODY RECORD k ��Page�� or — <br /> Contact Person n Projectinfo Turn Around Time <br /> Company F a,,.� n `k �-��cJ c �/ <br /> PO # E9-Normal <br /> Address 9 i�1 16 W i c ra. A.,c boa City c rto Stated Zip YIR,2-7 Prolect # <br /> Rh <br /> Phone n L I C O a-3 FAX ���� -C - �a Project Name c o q 3Y Specify <br /> Collected By Signature L �� <br /> DField Sample 1 D Date &Time Analyses Requested Canister Pressure 1 Vacuum <br /> Intlial Final Receipt <br /> ulshed y natural 1l `I Print Name Notes <br /> Relinquished ,gnaturn) DatelTime Received 13r(Signature) Datelrime <br /> Relinquished By'(Signature) DatanIrne Received By r y NDa a r <br /> Lao Shipper Name Air DID ,� By 45ateMme Tamp (°C) CcAddion Custody Seals Iniac work Order 4r <br /> Use 1 1S1l.t U1 ) Yes No N/ 5 2 O <br /> Only <br /> Foim 1203 rev M <br />