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' 180 BLUE RAVINE ROAD, SUITE B <br /> 719 <br /> AIR TOXICS LTD. F 16) 985 CA 95fi3X (91 <br /> (91B) 985-1000 FAX (916) 985-1020 <br /> a <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY 001611 <br /> CHAIN-OF-CU§TODY RECORD Page -1 Of I <br /> I i <br /> Contact Person :J'oAAmvi t ler Project Info Turn Around Time <br /> Company t, P O # 156 7—0 _ 3INormal <br /> Address;3142S() 5vsk�ri. tClty ate ZlpW-50 Project# _ 1567 - ❑ Rush <br /> Phone <br /> 1$51095-7 99J O FAX . �0 7 a��7-- Project Name CZ ULai Specify <br /> Lab Field Sample I D. pate & Time s Analyses Requested Canister Pressure 1 Vacuum <br /> I,D.> I Initial Final Receipt <br /> J1A �5S C -- 1 -34-4/25- <br /> ' TL <br /> 05A 5 E - a — o t --- , <br /> , <br /> 9 <br /> II f F i f <br /> e <br /> � I <br /> Collecle, By Pnnt Signature Notes <br /> (� Lo i 1 <br /> Received$y (Signatu a Dat ,me <br /> Relinquished By (s. n lure) Datelrime ¢ � } <br /> Railquished By'tsignatwreT Dafefflm& Received By (Signature) Date,/Time „ <br /> Relinquished By (signature) Date/Time 11117 <br /> ed nature) + lqa <br /> Shipper 144me 11``,�, '',, Atr lII# Opened$ I�a`tel7imel 'nTem (°C) Condition Custody Seals fntac? Work Order# <br /> Lab QC— �+4�� ��:���7 �� �Z1gS �YI�I� i �p Yes No 0 <br /> Use _. <br /> 066 <br /> r <br /> ev 05 <br />