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AIR TOXICS LTD. 180 BLUE RAVINE ROAD, SUITE B <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY FOLSOM, CA 95630-4719(916)985-1000 FAX' (916) 985-1020 <br /> CHAIN-OF-CUSTOS RECjJJLJ41 N` nn� ? s <br /> Pageeof _ <br /> Contact Person — ISO/I Project into. Tum Around Time <br /> Company p)(c tJ r r c c w e s` PO #__ 060 L� Normal <br /> Address r1I I i� 1t - _ I'�+�e '�c�'CI#y C �,.�State jfA Zip9� Project # 0 ❑ Rush <br /> (ail ( �� � - C / � <br /> Phone FAX 6 PS-G Project Name 0 Specify <br /> Collected By signature <br /> Lab <br /> D Field Sample I D Date & Time Analyses Requested <br /> Canister Pressure/Vacuum <br /> Initial Final Receipt ` <br /> W T �. <br /> TP <br /> } <br /> F3�Gtn}qul�is{h@Ca ( /Time PnntName <br /> T/T <br /> � / Notes <br /> bet <br /> nrnqu;shed6le/roma <br /> Received By (Ssgnalure) te/Time ` <br /> neluigwshed By (Signature) DatefTime Received ey Sign u(e) b ime \ <br /> 1f S <br /> Shipper Name __ Alr Bt l# Opened By Dat&Tlme tem °C Condition CustodySeals Intact? Work Order#r <br /> Lab l <br /> Ilse ��i'/ Ul� Yes �No.. Non NIA 5 O 70 <br /> Only <br /> + . • 0 1293 rev 06 <br />