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Sample gspor hNotice <br /> AIR TOXICS LTD, RelinquishingTransportation <br /> on this document indicates that sample is being shipped in compliance 180 BLUE RAVINE ROAD SUITE B <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY <br /> with all applicable local,State,Federal,national,and international laws,regulations and ordinances FOLSOM, CA 95630-4719 <br /> of any kind. Air Toxics Limited assumes no liability with respect to the collection, handling or (916) 985-1000 FAX (916) 985-1020 <br /> shipping of these samples. Relinquishing signature also indicates agreement to hold harmless. <br /> CHAIN-OF-CUSTODY RECORD defend,and indemnify Air Toxics Limited against any claim,demand,or action,of any kind,related Page - of <br /> to the collection,handling, or shipping of samples. D.O.T. Hotline (600)467-4922. <br /> Contact Person �._� Project Info: Turn Around 1 Lab use only <br /> _ Time: 1 Pressurized by: <br /> Company Email _ j <br /> P.C. # ❑ Normal ? Date: <br /> Address City State Zip <br /> Phone__ Fax Project # I L❑ Rush Pressurization Gas: <br /> Collected by: (Signature)- <br /> Project Name specify 1. Nz He <br /> Canister PressureNacuum <br /> Lab I.D. i Field Sample I.D. (Location) Can# Date Time Analyses Requested , Initial Final I Receipt Final <br /> • I ipy <br /> ! I <br /> I <br /> i <br /> I � i <br /> t — <br /> Relinquished by: (signature) Date/Time Received by: (signature) Date/Time Notes: <br /> Relinquished by: (signature) Date/Time Received by: (signature) Date/Time <br /> Relinquished by: (signature) Date/Time Received by: (signature) Date/Time <br /> Lab Shipper Name Air Bill # Temp (°C) Condition Customer Seals Intact? Work Order # <br /> ! <br /> Use Yes No None <br /> Only -- <br /> 1 <br /> Form 1293 rev.10 <br />