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AIR TOXICS LTD. 180 BLUE RAVINE ROAD, SUITE B <br /> FOLSOM, CA 95630-4719 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985-1000 FAX (916) 985-102U <br /> CHAIN-OF-CUSTODY RECORD 1 !` rPage s_ of <br /> Contact Persson e K [So rl` Project Info Turn Around Time <br /> Company <br /> �r�c a�,.? �r o-411de- l� PO # " �� C� <br /> Address ql&_A c(v,n AQP W cx Q L f0 ' L�'Rush0-r m al <br /> City -1 ...._StateG� Zip�� Project # c.: C � 5 El Rush <br /> Phoned/w - o!a 3 FAX _�q�.�o� 95-6 - 5r? 7-7- Protect Name ���CC u r� �/ S`i` Specify <br /> Collected By Signature <br /> Lab <br /> Field Sample I D Date &Time Analyses Requested Canister Pressure/ Vacuum <br /> Initial Final Receipt <br /> OIC- F1 1 So IT L T <br /> 023-2 1110 X <br /> Rel (Shed B %dierrime 3-8 <br /> -If ,Print Name �r i/ Notes <br /> Relinquished By ( igna ure) DateMme Received By (Signature) ate/Time <br /> Relinquished By (Signature) Date/Time 71wed (Signature <br /> 2 S <br /> Lao Shipper Name Air i# Opened By Date/Time Tam (°C) Conddlon Custody Seals Intact' Work Order# <br /> I~1SP <7' i "o V0 QAP�ZjO [U� ?J j�1Sf2-lo y}�� ,t'� �j��� Yes No None NI <br /> Only <br /> Fotm 1293 tev 06 <br />