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Sample Transportation Notice <br /> Air <br /> Relinquishing signature on this document indicates that sample is being shipped in compliance with 180 BLUE RAVINE ROAD, SUITE B <br /> all applicable local,State,Federal,national,and international laws,regulations and ordinances of FOLSOM, CA 95630-4719 <br /> GTOXiCS <br /> ® any kind.Air Toxics Limited assumes no liability with respect to the collection,handling or shipping (916)985-1000 FAX(916) 985-1020 <br /> of these samples. Relinquishing signature also indicates agreement to hold harmless, defend, <br /> CHAIN-OF-CUSTODY RECORD and indemnify Air Toxics Limited against any claim,demand,or action,of any kind, related to the Page—t—of <br /> collection,handling,or shipping of samples. D.O.T.Hotline(800)467-4922 <br /> Project Manager Project Into: Turn Around Lab Use Only <br /> Time: Pressurized by: <br /> Collected by:(Print and Sign) P.O.# <br /> 16C4 allormal Date: <br /> Company el Email <br /> Addres y Pro ject# V7- 6f67q IJ Rush Pressurization Gas: <br /> State zip <br /> N, He <br /> Phon _Fa- Project Name specify <br /> Canister Pressure/Vacuum <br /> Date Time <br /> f <br /> ;o c� <br /> 1 ct <br /> Last. Field Sample I.D. (Locat7lon)7 Can# of Collection �of Collection Analyses Requested Initial Final Receipt Final <br /> (psi) <br /> -50'IVA) <br /> 7X3 VY(I <br /> 3) <br /> -50 <br /> R Dat e/Tim Receiyed�- y:(signatureDate/Time o es: <br /> 2,11�3 <br /> 6P 45 <br /> Relinquished by: (signature) Date/Time Received by:(signature) Date/Time <br /> Relinquished by: (signature) Date/Time Received by: (signature) Date/Time <br /> Lab Shipper Name Air Bill # Temp (OC) Condition Custody Seals Intact? Work Order# <br /> 7Nc <br /> Use Yes orae <br /> Only 1302067 <br /> Form 1293 rev.11 <br />