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AIR TOXICS LTD. 180 BLUE RAVINE ROAD, SUITE B <br /> AN ENVIRONMENTAL/1HALYTICAI_LABORATORY FOLSOM, CA 95630-4719(916) 985-1000 FAX (916) 985-1020 <br /> CHAIN-OF-CUSTODY RECORD ` fI P f-iPagl _ of <br /> Contact Person 0.1 ro ect Info Turn Around Time <br /> Q 1 <br /> Company � c..1 Qr� j <br /> q lc0�� PO # �C9 Cv 0 �armal� <br /> Address -- Al law► y� �y G State C� Zip Project # LO& o <br /> (o) �-{ o! El Rush <br /> Phone __ t{� �-j _ FAX Project Name ,�c /'J Specify <br /> 0 a <br /> Collected By signature <br /> - r-kry <br /> 7'0/Y <br /> Lab#' Feld Sample I D ©ate &Time Canister Pressure / Vacuum <br /> .a: Analyses Requested <br /> ' Initial Final Receipt <br /> _T/Y F <br /> $ xf L / <br /> f <br /> �aY <br /> s , <br /> 3 <br /> i <br /> IIelinguished By A'U <br /> e) PnntName Notes <br /> 'Relulq By lt Received By-(5 re) DalelTime , <br /> Relinquished Byr(Signalure) Datw i wm R By, re -Da e w <br /> `J� s i <br /> Shipper Name. s<t <, Ate 1ul3 : ;tDWeatme Tem °C) Condition CustodySeals Intact? Work Order# <br /> nx�„a3�7 <br /> �, ry IJSB (( /V4 /Un 9 5 4 <br /> �t! Yes No None N <br /> 4 11�/ 1A <br /> Form 1293rov 06 <br />