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AIR TOXICS LTD. 180 BLUE RAVINE ROAD, SUITE B <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY FOLSOM, CA 95630-4719(916)MA 000 FAX (91 6)985164 <br /> CHAIN-01F-CUSTODY R bib . �� n Page' ' <br /> Contact Person C`�E `� A e r r r <br /> ?J `�� Project info• Tum Around Time. <br /> Company "}r� '!, -PO # D Co O <br /> Address ]e_i.t, rtii 1 c c'v City (-L( Normal <br /> J o State LE Zip� Protect# O <br /> Phone W l ' I r I `I C 1 a� _ FAX C(I L) �5 Co _ 11 Rush <br /> S� �.. Protect Name EGD #L+3z Specify <br /> Collected 8y sgnawre a4 J <br /> Sry C T'C, <br /> Lab Field Sample I D Date & Time Analyses Requested Canister Pressure/Vacuum <br /> I D Initial Final Receipt <br /> 5 3 y /W- <br /> r% z / bo TP W <br /> ti <br /> �Fite nquished B A(slmr4Dapme IS I� Print Name Notes <br /> �f�ehnquishedBt. (5rg acutel Dat _ ---__{leceryedBy�SignatureOalefrrme <br /> Ftr6nqurshrd By (Signature) Bllcffrme fi ceived By (Srgn urlefT e <br /> -- � Az— <br /> Shipper Name Air Bili Oened By Daterrime temp °C) Condition 'Custody Seals frttac#7 Work Order# <br /> Lab <br /> Use + t < < �=14 Yes No None N1q 9 5 5 <br /> Only <br /> 4 <br /> f <br /> Sm 1293 rev 05 <br />