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oft <br />r Q fins <br />Sample Transportation Notice <br />Relinquishing signature on this document indicates that sample is being shipped in compliance with 180 SLUE RAVINE ROAD, SUITE S <br />AirToxicall 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 />and indemnify Air Toxics Limited against any claim, demand, or action, of any kind, related to the <br />Page of <br />collection, handling or shippingof,sampies. D.O.T. Hotline (800) 467-4922 <br />Project Manager <br />project Into: Turn Around 4ab,Usa my <br />Collected by: (Print and Sign) <br />,. t Time: PressurtxaWl� <br />P.O. # <br />Company <br />[ Normal <br />Email <br />1 Project ## , C� Rush <br />Address _ laSr. <br />c ity if1; . "` . State Zip PresUrizabon <br />yy� <br />R. <br />Project Name ?—'� �r.. , — <br />Phone <br />Fax ;1� speguy. N2 He <br />Date Time Canister PressureNacuum <br />Lala iryp ` Field Sample I.D. (Location) Can # of Collection of Collection Analyses Requested Initial Final Receipt Ful' I <br />by: <br />Relinquished by: (signature) Date/Time <br />Received by: (sl <br />Received by: (signature) Date/Time <br />Received by: ( ig ature) <br />YS/5 <br />IN <br />Form 1293 rev.11 <br />yy� <br />R. <br />by: <br />Relinquished by: (signature) Date/Time <br />Received by: (sl <br />Received by: (signature) Date/Time <br />Received by: ( ig ature) <br />YS/5 <br />IN <br />Form 1293 rev.11 <br />