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+ri � ram �w �� �� �� w■■f w,■ a� I• ■■� � � �� I• <br /> AIR TOXICS LTD. 180 BLUE RAVINE ROAD,�JDITE B <br /> FOLSOM, CA 95630-4719 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985-1000 FAX (916) 985-1020 <br /> CHAIN-OF-CUSTODY RECORD 027880 <br /> Page of <br /> Contact Person -"- �' � Protect info Tum Around Time u <br /> Company :'' '" s "ge <br /> r, <br /> PO # rq Normal <br /> Address , ' R` ' L* Clt f6 -� <br /> y Stated zip Protect# _ ❑ Rush <br /> Phone t .:S =;t � - -0 I ZZ2 FAX ����1 �>���' �� 3 � - Specify <br /> -f � ...- ��',.. Protect Name ���. � ; ,�-,� <br /> p <br /> Collected By Sigriatuse <br /> Lab <br /> I D Field Sample I D Date & Time Analyses Requested Canister Pressure / Vacuum <br /> Initial Final Receipt / <br /> (1� �tGc� SA.j' t.1� 1� G /til" ej ' -.6�Ui� %' - ' � • <br /> iii leg <br /> fit <br /> _ t _ <br /> � A ✓i:3 <br /> RelingY thec# y (Signature} Dale/Time Print N me / - 0 Notes <br /> Relinquished By (Signature) Datefrime Rgre By (Si ture) Date/Time <br /> Relinquishedby (signature) Datefrime Received By (Signatur Date/Time <br /> Shipper Name Air Bill# Opened By Date/Time To (°C) Condrtion Custody Seals lntacO Work Order# <br /> Lab _ I - <br /> LIS$ t t L_�l! f ,L ")1 r �: ! /,c1 i; ( n I �,4fr )/ Yes No !None NIA <br /> Only ,} %�"] __ _01-0-1 0 4 D <br /> Form 1243 rev 06 <br />