Laserfiche WebLink
------M. _w --- w M M <br /> Sample Transportation Notice <br /> OTOXiCSLTD.r Relinquishing signature on this document Indicates that sample is being shipped in compliance with 180 BLUE RAVAIr INE ROAD, SUITE B <br /> all applicable local,State,Federal,national,and international laws,regulations and ordinances of FOLSOM, CA 95630-4719 <br /> -5 any kind.Air Toxics Limited assumes no liability with respect to the collection,handling or shipping (916)985-1000 FAX (916)985-1020 <br /> of these samples. Relinquishing signature also Indicates agreement to hold harmless, defend, <br /> CHAIN-OF-CUSTODY RECORD and indemnity Air Toxics Limited against any claim,demand,or action,of any kind, related to the Page of <br /> collection,handling,or shipping of samples. D.O.T. Hotline(600)467-4922 <br /> Turn Around Lab use Only <br /> Project Manager 'R2 01,L,--� Pro Iact Into: Time: Pressurized by: <br /> Collected by:(Print and Sign) J m I'IA6Lr4hs p,o.# ormal <br /> Date: <br /> CompanyAl oris Email .h/YnLnda lel-e eec�w< 1 <br /> Address city (d State Zip Project# ❑Rush Pressurization Gas: <br /> Phone <br /> �l y. /)R',�'��-5 Fax Project Name •3o&&70 s�'�k/'��'1 ,�yy N2 He <br /> Date Time Canister Pressure/Vacuum <br /> Lab I,D. Field Sample I.D.(Location) Can# of Collection of Collection Analyses Requested Initial Final Receipt FPa�I <br /> 7r .r4• r Tom, <br /> p( S V-f /59z 9 9 %U �n�Q lgra p< csy a -3 -17 <br /> pawT7 c/ qt -10—fD /4nt <br /> 6- 1i <br /> Rf in fished b •(signature) Date/time R ed by: (sign lure Datelnime Notes: <br /> I've i D �d 3 _ C ibolfu o ` <br /> Relinquis ed by:(signature) Date/Time Received by:(signature) Date(Tlme <br /> Relinquished by: (signature) Date/Time Received by:(signature) DateMms <br /> Lab Shipper Name Air Bill # Temp (°C) Condition Custody Seals Intact? Work Order# <br /> Use p Yes No ne p <br /> only <br /> "" Form 1293..11 <br />