Laserfiche WebLink
I <br /> TOXICS 180 BLUE RAVINE ROAD, SUITE B <br /> AIR QXICS LTD. FOLSO , CA 95630-4719 <br /> (916) 985-1000 FAX (916) 985-1020 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY <br /> MITI 00279S <br /> CHAIN-QF-CUSTODY RECOkb Page , of <br /> Contact Person �1 ridCompany { +� �4 ��� <br /> (� Jt rt/ Project info• Turn Around Time:r ( C' PO # o20Gs , ,� <br /> Address qh f(, ,'i�C= t��p � ' Clty c �a "�'�°� tateC� Zi ��8�� W-formal <br /> p Project# 6;06 S ❑ Rush <br /> Phone LL_( ' y�? �� FAX ` � � S — S� Project NameA �v 3 Specify <br /> Lab L-d� <br /> D Feld Sample I D 7Date & Time Analyses Requested Canister Pressure/Vacuum <br /> I r Initial Final Receipt <br /> /�r l� - �� s <br /> 1-30c PH 67-)< <br /> � <br /> Collected By pnm Srgnalur <br /> _ Notes <br /> Relinquished By (Sign rel Dat l ne Z Received By (Signa re) Dale/Time <br /> vs^ <br /> Relinquish, By (Sr alure) Date/Time �� r <br /> ��ieeeroEd y (&gnalure) DaterTime N <br /> Relmqurshed By (Signature) Dile/Time J <br /> _ - AecerveBy ig� urr �pa me <br /> k�� OIL— <br /> Shipper Name AIr Bill# Opene By Date/Time Temp °C �Cond�,dflonlCustody Seals Int Wrk Qrder# <br /> I_ab ,Use f, (1,1, tOnlyYes No one95 <br /> • . orm 1293 rev 05 <br />