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i • 0 <br /> AIR TOXICS LTI1, 180 BLUE RAVINE ROAD, SUITE B <br /> I@ ' FOLSOM, CA 95630-4719 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985-1000 FAX (916) 985-1020 <br /> CHAIN-Off'-CUSTODY RECORD "I "'"f"ge of <br /> FContactPersonn��: <br /> G� E!5 0,� ProjectInfo Turn Around Time <br /> y f a J 4JC D C� <br /> u�Jr ut6� c o P O # El Normal <br /> Address <br /> City � '� State K ZIP Project# y�' ) ` <br /> Phone O/523 FAX 16 1�,5( - �� Project Name �� /ZC.o Rush Specify <br /> - � Z� 3� <br /> Collected By Signature <br /> S7-6 To N/ <br /> LAb Field Sample I D Date&Time Analyses Requested Canister Pressure /Vacuum <br /> Initial Final Receipt <br /> r <br /> fished 8y: ref Ielriumm Pant Name Notes <br /> 3-Z?`K — <br /> RettnquLshed y ( gnature rwe/rtme Received By-ibignaturey oete/Tum <br /> Rehnqurshed By (Sgnature) DaterTime B atur I&TIM <br /> Iq <br /> • 't v t 'I'itlte T m (°C Condition Custody Seal intact? Work Order# <br /> �' 188 ►�7 � I�S�gj'31+ -" t �y�v Yes No No !A9503258 <br /> �A 3 <br /> r `7� <br /> � <br /> � x <br /> Y ' t Form 1293 ray 06 <br />