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AWa <br />Sample Transportation Notice <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 />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 S"Project Info: <br />Turn Around ; Lai Use only. <br />Time: PresSy.rized by. <br />Collected by: (Print and sign) 'Ll") , &4.4 <br />P.O. # ❑Normal pate; <br />Company ie :l- tri Email Project # ❑ Rush P r . esSurizati o : nt Caas: <br />Address _ !;17'A6 P rlye- A)a City tAC tri State Zip <br />Phone t '° S w Fax _S�zi�i Project Name Specify N2 Ne <br />Date Time Canister Pressure/Vacuum <br />Lab I.D. Field Sample I.D. (Location) Can # of Collection of Collection Analyses Requested Initial Final Receip# Finelal <br />Form 1293 rev.11 <br />—0 0 <br />Q�k' <br />'z• <br />a3� <br />L <br />�7 <br />C3 <br />Relinquished b : (signature) Date/Time <br />Recei ed by: (signature <br />DateMme <br />Notes: <br />t 4f: SD <br />S <br />Relinquished by: (signature) Date/Time <br />``��' 1V <br />Received by: ( ignature) <br />Date ime <br />4;ti <br />2 7 <br />Relinquis d y: signa re) Date/Time <br />Received by: (signature) <br />bateffirne <br />,Lab -Shipper Name <br />Air Bill # <br />Temp' (°C) Condition <br />Custody Seals Inta' t? Work Order #' <br />Use <br />Yes No None; <br />"Only. <br />Form 1293 rev.11 <br />—0 0 <br />