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AIR TOXICS LTD. 180 BLUE RAVINE LOAD, SUITE B r <br /> FOLSOM, CA 95630-4719 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985-1000 FAX (916) 985-1020 <br /> CHAIN-OF-CUSTODY RECORD l'4: 00 t (, 6' <br /> Page _ of <br /> Contact Person Project Info Turn Around Time <br /> Company 3 n G. <br /> F P O # <br /> Address /KI c ion City State �&Zip Protect # El Rush <br /> Phone q lD ��( t( o� 2 FAX _ 216 S'S-6 " SY��'7� Project Name R� #�� Specify — <br /> Collected By Signature <br /> Lab Field Sample I D Date & Time Analyses Requested Canister Pressure / Vacuum <br /> 1D. Initial Final Receipt <br /> .A �N <br /> f�7l <br /> fi'� <br /> nquished lure) 6 S 4} P.1 Name /7 Notes <br /> Relinquished 9y (signature) ❑ate/Tune 5ipriature) Dat me <br /> Relinquished By(5ignalure) Data/Tim Received B (signature) Dale'Time <br /> Shipper Name Air Bill# ned By, _ Dalarrime Tem (°C) Condition Custody Seats Intact? r r <br /> Lab <br /> 1 Use h I o-0 O t t Yes No None NIA <br /> Only <br /> Foim 1291 joy W <br />