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i I <br /> i <br /> ' AirSample Transportation Notice <br /> 2T0xj1A61RftA-JL"LTD. <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 /> zaetx�sa�nr <br /> Project Manager Ztla 13RvS Turn Around Project Info: , <br /> Time Ptstlttzc by <br /> Collected by:(Print and Sign)^�c�F i�P. SCA "► r <br /> nn__ P.O.# Normal <br /> CompanyDpp fZuSrA-A&.C.,:,A':'ES -t(.Email RvS' <br /> Address FO QUY 332— City 2 !s7tate c=/Zip Project# t 1� ' 00 Z- R ❑Rush <br /> Phone Fax iW G t - 1 Y3-� Project NameLt�71� yP 4.5-AtJr- specify f He <br /> Date Time Canister Pressure/Vacuum <br /> f�skF b Field Sample I.D.(Location) Can# of Collection of Collection Analyses Requested Initial Final .Fleceipt 4F1 <br /> SG-IM lt/ IL1 (A 1 Z r (tr.Zz SSE �vTis �UnU -3D ;A <br /> M iA/Z i i-z3 4P <br /> linq hed by:(signature) D teTme Received by:(signature) DatefTlme Notes: N A-i.YS�s <br /> I r <br /> z� ,- 13 - 4(, (5 le'W19 M -- Vo s r , EP4 To�� <br /> inquished by:(signature) DatelTime Received by:(signature) Datefl-ime —maD A-STM D- (14& = r-da, <br /> imr =,oxy&,,CARR-q-1 p avy <br /> Relinquished by:(signature) DateTme Received by:(signature) DaterTme N{ <br /> PSz�,vo�� (Rtf3vt2.bo $�o <br /> Use cao a Na tyn 1-8014U <br /> Fo-1293—11 <br />