Laserfiche WebLink
---------- ---- ---__ _------ -- ------ - -------------------- ----- <br /> TO-1 7 SAMPLE COLLECTION <br /> _l AAW Sample Transportation Notice <br /> ir Relinquishing signature on this document indicates that sample is being shipped in compliance 180 BLUE RAVINE ROAD, SUITE B <br /> MF with all applicable local, State, Federal, national, and international laws, regulations and <br /> ordinances of any kind. Air Toxics Limited assumes no liability with respect to the collection, FOLSOM, CA 95630 <br /> I OXICS <br /> ® handling or shipping of these samples. Relinquishing signature also indicates agreement to hold (916)985-1000 FAX(916)985-1020 <br /> harmless,defend,and indemnify Air Toxics Limited against any claim,demand,or action,of any <br /> CHAI,N-OF-CUSTODY RECORD kind,related to the collection,handling,or shipping of samples.D.O.T.Hotline(800)467-4922. Page-of <br /> Project:Manager all r—i Project Info: Turn Around Reporting <br /> Time: Units: <br /> Collect led by:(Print and Sign) y <br /> P.O. J'ppmv <br /> O. # J Normal <br /> Com p an yc Email J LJ ppbv <br /> ;k <br /> &e dQ� <br /> e "Z,p Project# J Rush <br /> Address M ,ty at 0,1Z AeLr—&W LJ pg/m3 <br /> Phone Fax a x 91, 2 A51— 1Project Name le-i-1 specify ❑LJ mg/m3 <br /> < �5 <br /> E5 CL <br /> Date of — 0 <br /> Start Time End Time Pre-Test Post-Test Indoor/Outdoor 0 - <br /> Lab L D. Field Sample I.D. (Location) Tube# collection Volume <br /> (mm/ddlyy) <br /> (hr:min) (hr:min) Flow Rate Flow Rate %RH Temp <br /> L?U <br /> Ll LI a L) <br /> AIN _'5� 77 1511/-C 410J, <br /> 7 <br /> 60 J J Ll El <br /> LJ Ll 6dp <br /> elm, <br /> Ll Ll idp <br /> V-I <br /> ;�110 LJ LJ 2L] <br /> 0000 <br /> I I <br /> LJ LJ LJ LJ <br /> LJ Ll J J <br /> 0000 <br /> LI LI Ll Ll <br /> Relinquished b (signaf�r Date/T me Received by:(signature) Date/Time Notes: <br /> y I / <br /> &I/-rf 1pg­ <br /> Relinquished by:(signature) Date/Time Received by:(signature) DateMme <br /> Relinquished by:(signature) Date/Time Received by:(signature) Date/Time <br /> Lab Shipper Name Air Bill# Temp CC) Condition Custody Seals Intact? Work Order <br /> Use Yes No <br /> Only <br />