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i �a <br /> P <br /> AIR TOXICS LTD. 180 BLUE RAVINE ROAD, SUITE B <br /> FOLSOM, CA 95630-4719 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985-1000 FAX (916) 985-1020 <br /> CHAIN-OF-CUSTODY RECORD t ' 'Page'— <br /> Pages— of <br /> Contact Person �'^ Ko r_ e!5o n Protect Info Turn Around Time <br /> Company o u1 .--�k1.)e. i PO # e U C�, � C9"'No" <br /> rmal <br /> Address qWL' _A c ton Au�E 464" City 6a4--to StateCA Zip'20?i2l Project # ❑ Rush <br /> Phone - 01 3 FAX q {o.� � - S� Project Name Ix_"c D :?�e3 Specify <br /> Collected By Signature -T)17 AA4J <br /> Lab Field Sample I D Date &Time Analyses Requested Canister Pressure/Vacuum <br /> I'D. Initial Final Receipt <br /> 61N 3, )75go <br /> TA <br /> Re!= matefrim 3.8 .IS ,Pratt Name � Nates <br /> t 05" <br /> Relinquished By { gna)ure) Date/Tone Received By (Signature) Dateffime <br /> Relinquished By (Signature) DateRme c4dived (Signature <br /> 'L. S <br /> Shipper Dame Air EW# 0 ned By. Datemme Tamp (°C) Condition Custody Seals intact? Work Order# <br /> Lab <br /> I,J$p- � t�.r� �J �!s(Zl� 11��'-+1T- vJ�»� Yes No None NI <br /> unit - <br /> Form 1293 rev 06 <br />