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® - S Sample Transportation Notice <br /> r i S R elinquishing signature on this document indicates that sample is being shipped in compliance with 180 BLUE RAVINE ROAD,SUITE B <br /> Air 'CS alI applicable local,State,Federal,national,and international laws,regulations and ordinances of FOLSOM, CA 95830-4719 <br /> any kind.Air Toxics Limited assumes no liability with respect to the collection,handling or shipping (916 <br /> of these samples. Relinquishing signature also indicates agreement to hold harmless, defend, )985-1000 FAX(916)985.1020 <br /> and indemnify Air Toxics Limited against any claim,demand,or action,of any kind,related to the <br /> collection,handling,or shipping of samples.D.O.T.Hotline(800)467-4922 Page of <br /> Project Manager 1 )G i � �i li aUl v3"Z — Turn Around Lab use only <br /> 1 �q Project Infer <br /> Collected by: <br /> ii(Print and Sign) �� UR ��k.elye"' — i _ (� Time: Pressurized by. <br /> Company �7A(4y1C°&� 0f66ViNh,, �1 ill,0 /Veyrk *?�{� � .O��i � Ike, IYuat t � X'Normal Crate <br /> p yP� uw� Email ,. �}A �[. <br /> Address Z7�7 a(ic wo V City State,- Zip 3-21 Project# j ,r t�C{ 7f bSf �r(b� Rush Pressurization Gas <br /> Phone (0 Fax �OQ-6]lyP >1 6 Project Name U"!i ti S� C v specify N2 He <br /> Date Time Canister Pressure/Vacuum <br /> Lab 1A Field Sample I.D.(Location) Can# of Collection of Collection Analyses Requested Initial Final Receipt = Fin til <br /> VLA 1A \A,) z C% ILl �` r� ac It-w J-euel if/�JCS � (G) <br /> far, <br /> 03'0'k, V AP \)L) - V-bvVv-,, 3 27 in2n_ <br /> Relinquished by:(signature) Date/Time R eiv d by:( 'gnature) DatelTime WhO W Notes: <br /> R pN, EtkT� U�17 <br /> Relinquished by:(signature) Datefrime Received by:(sign ure) DatelTime <br /> Relinquished by:(signature) Date/Time Received by:(signature) Date/Time <br /> Lab Shipper Name Air Bill# "Temp(OC) Condition Custody Seals intact? Work Order# <br /> Use V o Yes No Na 7 <br /> Only <br /> Form 1293 rev.11 <br />