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SORBENT SAMPLE COLLECTION <br /> Sample Transportation Notion <br /> Relinquishing signatuna on this document indicates that;arrplc is tieing shipped in compliance 180 BLUE RAVINE ROAD,SUITE B <br /> sAirwish all applicable veal, State, Feccral• nationa, end intemational laws, regt.lations and <br /> ordi iawes of any ldnd.Air Toodoe limited assumes no liability Wit~. Msp®ct )0the collection, FOLSOM,CA 95 O-4719 <br /> ToxiLTD.c✓ handling or shipping of those samploG.Relinquishing signature also indicates a:),wmsn_to hold (Bis)NS-1000 W(91$)` -1020 <br /> har'rnlas�c efend: and inde nnHy.QVr toxics UrNbd agaiist any cairn,d3rnwd,or action,of an/ <br /> CHAIN-OF-CUSTODY RECORD land,related to Vic collection,harr9ing,er ah Aping of samples.D.O,-Hotline{cool 4674922_ page pf t <br /> Project Manager C Project Into., Turn Around Circle Reporting <br /> Time:- Units: <br /> Collected by_;Pr rtt and sign~ fell <br /> P.O. J ormal <br /> Company + �3fp�L. Email ppbv opm� <br /> bila (�I� 6 i 7 C— Statef, Zia project l —/fid D` Rush <br /> Addres ug m mg/M3 <br /> 3 <br /> Phone `1l� Fax . Project Name �'a � any <br /> Tube#! Date of Start End Final <br /> Field Sample I.D.(Location) Duration Analysis Requested <br /> Cartridge-# Collection Time Time Volume 1 <br /> AST <br /> ^_. ' <br /> Re' quished by,(signature) DaielTirrc R (signaF_ure) Datef lme Pump Calibration InfotmaSon <br /> 1 ! W od e--�' ; , s . r a`1 1 Pre-test Flow Rale: <br /> Relinquished 4 . (signature) DatelTime R mivwlhy:(signature) Dait&Fiime Post-te;t Flow Rate: <br /> Relinqu'shed by. (signature-) DaterfimeReceived by:(signature) DrteJTime Average Flow Rate' <br /> Notes: <br /> la '.� '.i —: <br /> 'plEl'Si�r:�-'.:..`_'.' 'Zi•�`1!Y11]11_ � _ �•'=-% _ <br /> :SMc• �IaIR'te:=- -- -iAgr•_�►I�:�: :�>?±Iz }� _ <br /> ate;} Yes No None Q86 <br /> � — <br />