Laserfiche WebLink
SORBENT SAMPLE COLLECTION <br /> Sample Transportation Notice <br /> / Relinquishing signature on this document indicates that sample is being shipped in compliance 180 BLUE RAVINE ROAD, SUITE B <br /> with all applicable local, State, Federal, national, and international laws, regulations and <br /> ToxiCS LTD ordinances of any kind. Air Toxics Limited assumes no liability with respect to the collection, FOLSOM, CA 95360-4719 <br /> handling or shipping of these samples.Relinquishing signature also indicates agreement to hold (g16)985-1000 FAX(916)985-1020 <br /> harmless,defend,and indemnify Air Toxics Limited against any claim,demand,or action,of any <br /> CHAIN-OF-CUSTODY RECORD kind,related to the collection,handling,or shipping of samples.D.O.T.Hotline(800)467-4922. Page f Of <br /> Project Manager— +- ;;S;r-°`rte Project Info: Turn Around Circle Reporting <br /> `., j{F itFr fJ ' �r" Time: Units: <br /> Collected by:(Print and Sign) F1 « ,, .:;.f(4,., <br /> = P.O.# lsllormal <br /> Company � � >f r Email ppbv ppmv <br /> Addres '?`p `jt rr I r ;1 ��r%City# '..f ,., C State���:'Zip`iia"* r Project# :/ I - f ..1 Rush <br /> r <br /> r �3 06 C,:% ug/m3 mg/m3 <br /> Phone I�cf �`( p fY, ri { r` 1. ) f► <br /> Fax �.. __..: Project Name t_ F`2' f speedy <br /> / <br /> Lab I.D. Field Sample I.D. ube# Date of Start End FinalD.(Location) Duration Analysis Requested <br /> Cartridge# Collection Time Time Volume <br /> r.I <br /> Relinquished by:(signature) Date/Time Received:(signature) Date/Time Pump Calibration Information <br /> Pre-test Flow Rate: <br /> Relinquished 6y:(signature) Date/Time Received by:(signature) :Datd/Time Post-test Flow Rate: <br /> Relinquished by:(signature) Date/Time Received by:(signature) Date/Time Average Flow Rate: <br /> Notes: <br /> LabShipper Name Air BIN# CoPOPPtti Custody SealsWork Order <br /> Use <br /> Only `^ u'F'< - Yes No , None <br /> .. 7 <br />