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180 BLUE RAVINE ROAD, SUITE B , <br /> AIRTOXICS <br /> � r r� FOLSOM,CA 95630-4719 <br /> 1 t , <br /> OXICS LTD.D. (916)985-1000 FAX (916)985-1020 f� <br /> 1 <br /> AN ENVIRONMENTAL ANALYTtCAL LABORATORY *t n 00 2(J{ 1] F <br /> �� <br /> Ci1ALr-0' 1P-Clusf Voir R" E' 6VR1-1 6- 1 Page _ of — <br /> Contact Person Project Into: Turn Around Time: <br /> Company P Q #,Aak*- mal <br /> Address r.� I '�{�^ #�a' Clty (ti^^ �i° State ZIp45 Prosect# x2060 ElRush <br /> Phone 1 �� �{ - r FAX �` ��� ��� - L277- _ Prosect Name IWO ;-I 33 Specify <br /> Lab Field Sample I D Date & Time Analyses Requested Canister Pressure/Vacuum <br /> I D _ Initial Final Receipt <br /> I N F "o(-q5 love -v <br /> Gf- F �.. <br /> Collected By Print �} sign - Notes <br /> ___r_L <br /> Retlnquished By (sig re Date ime 7"[i_ q S Received By ( ignature) oatemme <br /> Rehnqu shed ay ( Vature) batefr me Rece ved ay (Signature) Dateliime <br /> R21,nti,rish- y (Sutn,tu,<1 I)itrli�me ---- ReSe ed nature) Dat Rne- �� 1 <br /> t ' q s <br /> Shipper Name Air gill # Opened By DatelTlme Tem (°C) Condition Custody Seals Intact? Work Order# <br /> Lab <br /> Use _ },! '_ I I ittNl Q Pt--ri) J�JJ106 NJ PMF 01? I Yes NO one <br /> Only <br /> • . arm 1293 rev 05 ' <br />