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! • • - - . <br /> AIR TOXIC$ UP* 180 BLUE RAVINE ROAD, SUITE B <br /> FOLSOM, CA 95630-4719 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985 1000 FAX (916) 985-1020 <br /> JAIN-PV-CJJSTODY RECORD '' Page-_ of- <br /> Contact Person Prolect info Turn Around Time <br /> Company PO # '�b t(�' <br /> _ S ITNormal <br /> Address ity ���7`�StateC� Zip � 7 Project# L'�C S ❑ Rush <br /> Phone - 0/.XFAX 3� l t Specify <br /> Pra}ect Name <br /> Collected BY.Signature <br /> Lab Field Sample I D Date &Time Analyses Requested Canister Pressure/ Vacuum <br /> Initial Final Receipt <br /> C - <br /> R fished B .( cure} ime 16 36 Print Name Notes <br /> Rehrlqu15nea By atura} Da Recenred By(S"ture) Dated7irne <br /> FL4b <br /> sh d�By (Signature} Date/retie Flkewr ed By atu Da2110ATr- <br /> Ll pyr> <br /> U ►63o � <br /> Shl r amp � ned(� , #eClhrip T m {°C Conc!W CustodySeals Intact'? Work Order# � <br /> Qg .�( � lt�l l Q� Yes No None��-10-4-0-3-6 <br /> Y1�1 t (' NA �In ref,L ly <br /> Form <br /> 1293 rev 06 <br />