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IMMIM w M M® r MM M MM WIM MIM M <br />MAir Sample Transportation Notice <br />RelinquiSningsignmvreogthis documentmdicateethetsampiei£00ingshipxclinicompliarrPwith 180 BLUE RAVINE ROAD, SUITE B <br />IOX <br />all =local, State; Frderal, naiianal, and international fa%z. rrgulationsand ordihances orf FO SOM, CA $5630-4719 <br />; e <br />any k nd.AirTosiGa Limited assumes rc liala ity with respect to tie ccllecti�n_ harWing .: ;h �piriq 1916) ,�85-100 FAX (916) 9$5-iQZt? <br />of these samples. rtelirquishing sgnature also irdicatias astreFment to hold harmless, defend, <br />CHAIN -OF -CUSTODY RECORD and indemnify A:rToxics UnrWd z;ganst any claim, demand, or action, of any klndl mlaMd to tete <br />collection, handling. cr stii�ppin� of samples. D.D.-. Hatline (800)457-4822 Page 0' <br />Project Uanager -'�N" 5e5 Mk * ry!' <br />Oottected 4y, (Pnta'fJSion) kl@ AfA-t � Ci'Stl� <br />tt <br />Corrcpar}r S i -Q c�GS Enna'I <br />ndcr�a^c City <br />PhcnP Fax <br />State_„_ <br />ZipFYoject <br />Project Info: <br />yC <br />- <br />� <br />r <br />Project NaRrie-5P <br />Turn Around <br />Time: <br />Lib U --:'07k ... <br />F?t ?SEtrjZBC:i}}K: f <br />Date: <br />;Frf�S�ctriz3tiOn:�at?S: " <br />- tJ� H�' <br />�! Normal <br />❑ Rush <br />L.2bk.D. <br />Field Sample I.D. (Location) <br />Can # <br />Date <br />of Collection <br />Time <br />of Colintion <br />Caniver Pressurerlraouum <br />Analyses Requested ni:ial Final Receipt .... . <br />09 <br />Relinquished by: (signature) oatamme <br />Rel inquish�ed�by: jSr_inature) `Uat? I irne fR 17'11) <br />Received by: (s*gnaiure), <br />Dale,-Tiw- <br />I Ai <br />I �s � <br />lot <br />Notes: <br />Rweivetl by ( gnaiure) DateM nc <br />rg , fixe) r3pr&-Rme <br />Relinquished by: 16, <br />Received 6y (sign re) U�U/7me <br />Lap: Shipp r lame Air -till <br />#' <br />:Tcmp (4C} Gondition <br />: Ct,l Jody SeGis Nita t? .. <br />'YVoek <br />Only - ; <br />R= IM rat•• <br />