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eurofins <br />-Fox ics <br />Sample Transportation Notice <br />Relinquishing signature on this document indicates that sample is being shipped in compliance with <br />all applicable local, State, Federal, national, and international laws, regulations and ordinances of <br />any kind. Air Toxics Limited assumes no liability with respect to the collection, handling or shipping <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 />collection, handling, or shipping of samples. D.O.T. Hotline (800) 467-4922 <br />180 BLUE RAVINE ROAD, SUITE B <br />FOLSOM, CA 95630-4719 <br />(916) 985-1000 FAX (916) 985-1020 <br />Page k of / <br />Project Manager 1.1iI Project Info: <br />P.O. # <br />Turn Around <br />Time:. <br />Lab (lie OnIy <br />Pressurized by. <br />Date: <br />Pressurization Gas: <br />N2 He <br />Collected by: (Print and Sign) De-v-e-n nivel. 5 .....-------z------' <br />54, Normal <br />J Rush <br />Company Sfr,rrtfee-- Email kied, DomrteSicroley„,-..c.) <br />Project # tes-7o3 766, .1t.A) t.:V453 4-- Address 3g 7c- A---theriun RA_ City 'ert:61:.--y\ Slate (_4 Zip qq-71;,-, <br />Project Name 67rOn e—r C1-1 /..4 6 e,_ Glev rutet Phone 606-i-i7 3 1 33 Fax specify <br />Lab I.D. Field Sample I.D. (Location) Can # <br />Date <br />of Collection <br />Time <br />of Collection <br />Canister Pressure/Vacuum <br />Analyses Requested Initial Final Receipt Final -(ps,) <br />01 4. 5V -I i t-P.G103 td -30 1 0((t,10 -r -ic f it -e -5 <br />0-1 Sv it_).67i oct C <br />0-34 , sv-3 I-a. I o c 5 >k/m-i-or, iv,0-1-N. -30 _s- wilmaimmi <br />Relinqui ed ay: (signature) Date/Time <br />11-3 - - I O. <br />Received by: (signature) Date/Time <br />e.J-__E)S. <br />Notes: <br />lz(elinquished by: (signature) Date/Time Reived by: (signature) Date/Time <br />vt"' .1. ft TL C2 D'Z Relinquished by: (signature) Date/lime Received by: (signature) Date/Time <br />Lab Shipper Name Air Bill # Temp VC) Condition Custody Seals Int‹? Work Order # <br />Use ir„, FA. 6 4- cfxxt Yes No 74;ne 1805044 Only <br />Form '293 rev.11