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� � i� � � � � � � 1• � !li I� � r i• � i• � � <br /> AIR TOXICS LTD. • 180 BLUE RAVINE ROAD#TE B <br /> t <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY 1=OLSOM, CA 95630-4719(916) 985-1000 FAX (916) 985-1020 r� ' <br /> CHAIN-OF-CUSTODY RECORD DP e _ of — <br /> Contact Person <br /> Protect info Turn Around Time <br /> Company - r� , Wa <br /> C' '� PO # Normal <br /> Address ,^� zr lam '' Cltp s r State t4Zip +�' Protect # ` r'� °-' =� ❑ Rush <br /> Phone ;�z�' .%��✓ .y #�&L' FAX �;1�.%" 62,92;L �'} _ Protect Name;5—m-,.L-tide -+tr. Specify <br /> �-r e.- <br /> Collected By signature � l�- `_� %' ... __. �. ^��`'t,t__r����t!c Ae—,al r�lL��Av` <br /> �Fl+ <br /> Lab Field Sample I D Date & Time Analyses Requested Canister Pressure/Vacuum <br /> I D, Initial Final) Receipt <br /> F" <br /> t _s ��l , '-f l !.✓ t7 V t L o � <br /> + s <br /> / ' Notes <br /> Relinquish d8y (__nature) Date/Time Pnnt Name f ; !' <br /> Relinquished By (Signature) Date/Time Recplve By (SI nefrl <br /> ature) Da me <br /> Relinquished By (Signature) Dalefrlme Received By (Signature) Date/Tlme <br /> Shipper Name Air Bill# Opened By Date/Ttrrie Temp (°C) Condition Custody Seals Intact? Work Order# <br /> Lab l L --,. <br /> Luseab I r'7 �i (11� t (U f 7 )i Yes No (None) NIA <br /> Only 0 r 7 -� <br /> __ 01 <br /> Foam 1243 rev 06 <br /> 4 <br />