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m•� Sample Transportation Notice <br /> eurofinsRelinquishing signature on this document indicates that sample is being shipped in compliance Wilt 180 BLUE RAVINE ROAD,SUITES <br /> AIC TOXICS all applicable local,state,Federal,national,and international laws,regulations and ordinances of FOLSOM,CA 95630.4719 <br /> any kind.Air Toxics Limited assumes no liability with respect to the collection,handling or shipping <br /> of these samples. Relinquishing signature also indicates agreement to hold harmless, defend,. (916)985-1000 FAX(916)985-1020 <br /> and indemnify Air Toxics Limhed against any claim,demand,or action,of any kind,related to the <br /> ccllecion,handling,or shipping of samples.D.O.T.Hotline(800)467-4922 Page—L of <br /> Project Manager MWSProject Info: Turn Around Lab use only <br /> Collected by:(Print and Sign) Time: Pressurized by: <br /> P.O.#- ❑Normal <br /> Company apa �F.(+FpJ,,�1. Email I kc <br /> "rO'N Date: <br /> Address 1��-1LLCI �ariar° City StateWL zip rajecf# _ bRpP�Bj� . CB�z. N�00 1°Rush�� Pressurization Gas: <br /> Phone Ct- MZ -y_,;� Fax ® Project Name <br /> ayedlyry Nz He <br /> .a:hua+ Date Time Canister Pressure/Vacuum <br /> Field Sample I.D.(Location) Canill of Collection of Collection Analyses Requested Initial Final Receipt Final <br /> - asu <br /> 10 ze►e.ed �e gA 4D i--. <br /> _ -- <br /> d��� <br /> A <br /> Relinquish0 1 nature) DateTme Peled <br /> _ ., Notes: <br /> 92 614 IBz <br /> w4LIS <br /> ita m4kRelnquish by:(s re) Date1me by ta/ /zac <br /> by:(signature) DateTme <br /> Relinquished by:(signature) DateJTime Received by:(signature) DateTme <br /> Lab Shipper NaypAlr BIII# (°C) r Custody Seals Intact? <br /> Work OYdet# <br /> T t� <br /> Use Yes No N <br /> Only one 141 <br /> 2 <br /> Form lze wil <br />