Laserfiche WebLink
>s <br /> irSample Transportation Notice <br /> 2 <br /> AN 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 /> ® 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 of <br /> collection,handling,or shipping of samples.D.O.T.Hotline(800)467-4922 <br /> Project Manager �gWn i _ S Project Info: Turn Around Lsb g Onty <br /> Collected by:(Print and Sign) J,Vpp =-- � Time: Pressurized by <br /> P.O.# ❑Normal <br /> Company S �®.�1ill�tree� Email Date` <br /> Address-.z/7�D r1ye-A,�Oy City� —State Zip Project# _ Rush Pressurization Gas: <br /> Phone Fax �9 _S'zJ / Project Name specify N� He <br /> Date Time Canister Pressure/Vacuum <br /> Lab I.D. Field Sample I.D.(Location) Can# of Collection of Collection Analyses Requested Initial Final Receipt Fina <br /> �° C3 Z-0 <br /> orooi <br /> 3® -_ <br /> Chi - 9a <br /> Relinquished b : (signature) Date/Time Recei ed by:(signature) Date/Time _ Notes: <br /> It 2- <br /> Relinquished by:(signature) Date/Time Received by:( ignature) Dat ime <br /> I1 Z <br /> it inquis d y: signa re) Date/Time Received by:(signature) ate�me <br /> Lab Shipper N;amp Alr dill# Terpp (°C) Condition Glastody.Seais Irita t? Work-Order <br /> Usei?tp� YC2 <br /> es Np ,None <br /> gnly <br /> Form 1293 rev.11 <br />