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AIR TOXICS LTD. Sample Transportation Notice 180 BLUE RAVINE ROAD, SUITE B <br /> Relinquishing signature on this document indicates that sample is being shipped in compliance FOLSOM, CA 95630-4719 <br /> with all applicable local, State, Federal, national, and international laws, regulations and (916)985.1000 FAX: (916) 985-1020 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY ordinances of any kind. Air Toxics Limited assumes no liability with respect to the collection, <br /> handling or shipping of these samples. Relinquishing signature also indicates agreement to hold <br /> CHAIN-OF-CUSTODY RECORD harmless, defend, and indemnify Air Toxics Limited against ny claim, demand, or action of any <br /> kind,related to the collection,handling,or shipping of saam'k,.D.O.T.Hotline(800)467-4922 page _ of — <br /> Contact Person �� t� G r��t- Gr project info: Turn Around Time: <br /> Company = P.O. # V <br /> Address /�90 `� � P� City Z�� � {State (Zip - Project# /r2 3" Normal <br /> f El Rush <br /> Phone7/( ��� �i�/ F X If���G a— h'� =�`� Project Name = � Specify <br /> Collected By:Signature — E� <br /> 1.D Field Sample I.D. Date &Time Analyses Requested Canister Pressure /Vacuum <br /> Initial Final llheceipt <br /> �X /iv 1/ lJ/ <br /> N <br /> - C <br /> q, <br /> as' <br /> i, <br /> Relingwshed By (Siggature Dale/Time Received By:(Signature) DateTme Notes: <br /> Relinquished By:(Signature) Daternme Received By:(Signature) DateTme h <br /> Relinquished 8y7-( <br /> Signature) DateTme received By:(Signature) Date/Time <br /> LaShipper Name Air Bill# Opened t3y: Temp. (°C) Condition Custody Seals Intact?" Work Order# <br /> b , r <br /> Use l _ `y Yes No - None <br /> Only <br /> Form 1293 rev.09 <br />