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L <br />1. <br />Sample Transportation Notice <br />R91irtqui,Wdtau sigriatureonihisdocumertindl,:amItintSampiei,;homr)sFippedircompliance %&lit: 180 BLUE RAVINE ROAD, SUITE 8 <br />all applicable local, Stats, Federal, nafcm .l, and inWnationai laws, egulations and ordlnanoes at FOL„ a�CiM, CA 9634.4719 <br />any Idnd.Air Toxics Llrrttetl Mvmes m I .ability wish aspect to the ca lagan, handling or ehiping 98$ 1000 FAX (916) 985-1020 <br />CO these samPtas. P,etinquishing signature alga irdica"e 8creement to hold ha miocw dcfcnd. <br />and indemrirfy Air Taxim U nilod a0airat any oWun, demmd, or action, of any kind, rilatad tc the <br />collection, handling: pr ahippiK of samples. D.O.T. I Iodine (80M 4407-4822 Page of <br />Projeethlanager _ +CA1 <br />�. <br />Project Info: <br />Turn Around <br />��rary,• •;.-..' ,• <br />. .. . <br />Collected by: (Print eW $;qnl Wli M <br />� J <br />' _ <br />Time: <br />,• . <br />Piressurizad by : : '. <br />Cornpany #? , WO61 Email <br />PO. # <br />Normal <br />Address _. __Gi'Y <br />$tats dip - - <br />Project /I <br />Frush <br />gresstiraat'ipr.:=Gad:: <br />Phone _ Fax <br />Project Namo.-'a <br />I <br />Date <br />Tirane <br />Canister <br />PressureVacuum <br />'Lab I.D. <br />Field Sample I.D. (Location) <br />Can # ofCol lection <br />of Collection; <br />Analyses Requested <br />Initial <br />Final <br />i. -Receipt <br />! iinal:, <br />' <br />".1j <br />0% <br />F �o�F } <br />� JJy <br />j` c� <br />! -T <br />-�y <br />P.+ a 6.?�L <br />`r <br />•''�t�br'/:�".. <br />•� <br />-+• t• <br />�' � <br />ll� <br />'�, <br />1140E <br />t <br />oU' Zia1 <br />l M API'lot <br />Ike -Al <br />VIA 0 <br />'l'Mi '11AIA <br />Islis, <br />1 <br />„ _ <br />•. <br />,,714 11-04 <br />ASIS <br />-amp <br />Relinquish b • (Signature me <br />�! <br />Receiveckby: (signatule,'l. <br />Derte,Tirn <br />tai <br />-1 � 3� <br />pUe9: <br />Roling nshp? 3 .TyiOrralure) Date/rn 61F a� Received by:=` nature) DatemnnG <br />Relinquishedgnature) Date'Time <br />Received by. ,signature; <br />Dat Tim <br />LabSltipperMam Air•Diil•# .Temp (,G; 'Condi#ionGuSk#tiy'S als:Jl FEw` <br />tl�aiprc <br />Use <br />' <br />-p„ o- <br />• '^` <br />.�1,� <br />� <br />r�, _ <br />:Yt?s: t�k>~ <br />.:Only., <br />Fvm 1;98 nw'.I I <br />M M M M M � M M MM MMM M M M MMI <br />