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f <br /> SORBENT SAMPLE COLLECTION <br /> Air Sample Transportation Nonce <br /> RAinquishing signature ae this docurnent indicates that sample is being shipped in complier ce180 BLUE RAVINE ROAD,SWIM B <br /> 0 with all applics�,le. Md, S=, +-ederai, national, and international laws, regulations and <br /> ordinances of any laid_Air Toxics Uniitad munres no liabiWy+.vHh :eepect tv the cpliection, EOLSOM, CA 9S -4719 <br /> LTD. handling or ship3?ng of these samples.Rdinqu skiing signature also indicates agreement to hold (9115} �1i]I�0 FAX{9yS)985-1020 <br /> y� harmless,eefend,and indemniy Lim <br /> AirToxios ited against any claim, demerd,or action,of any <br /> CHAIN-OF-CUSTODY RECORD <in+jeWed to thoeclleaior�handling,or shirp�ing afsarnples,C-0-T.Hotline(8014,37-4922- Page pf <br /> Pnofer~Manager I' lF Project info: Turn Around Circle Reporting <br /> Collected by,(Frirtwd&g iTrrec . ` Time. Units: <br /> R0.'� Normal <br /> Gomparly_ i:v _-ij E•na'17 ;j� it Loma" ppbv pprrly <br /> Addressa&j J'=W City Stata�Zip project it ❑Flush . <br /> j Phone F.6X 4(jij t IS Project Name i —77-77 u m mgIM3 <br /> Field Sam le LD.(t.ocation Tube#! Date of Start End Final psis R <br /> P ? Cart fdge# Collection Time Time Duration Volume "mal equesf:ed <br /> -70 <br /> 1 l4lirt �V�w�e <br /> i�o lit 2 lf?l i a 5ilsC <br /> 3 ! Ln <br /> IlkFlelinquislhed by;(si urs DaWTma —4 tay,{si�natune) Date/Time Pump Calibration Information <br /> yre-test now Rate: <br /> Relinquishcd . sl jnsture', DateiT nie Reo.aved by: (stgnature) Dat Ime fast-test Flow Rate: <br /> Relinquished by:(signature; DerwTime ReGeivsd by: ',signature) Datarr'me Average FIDW Rate; <br /> Notes; <br /> - . <br /> a . _. . . . - <br /> arfi #.: <br /> `:'T <br /> , <br /> N... .� a; `.r -first _ <br /> 1• J"" <br /> l ` ,' Yes kilo r No ) 1 ` <br />