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M = ® ® ® ® ® ® M ® ® ® ® = <br />ir <br />Sample'f snsportativn Notiee <br />ramTirnn <br />sTox <br />i <br />Relinquishing sgnatu rs on this rYsc�rnaa�! indir a that sample is being shippod in compl is-= with <br />a'.I appli able lomi. State, Federal, natonaf, and international laws, regulations and orcinances o <br />180 BLUE RAVINE ROAD, SUITE B <br />FCILS�7M; CA 95630-4719 <br />r <br />an{ ki nd, flit Taxica 6imited assumes no liabi�tty vrith rasp�t to the collection, handling or shippirg <br />of these samplss. Aeliuquiul ing signaiue also indicates agreement io hod riattniess. Zefend. <br />491 995-1000 FAX (91$) 965-1020 <br />CHAIN -OF -CUSTODY REbORD <br />wnd i•,deirnify Air Toxics Limited ags nst any elalra, darrane, cr amen. of any kinri. rplavd - :te <br />urt;i b4c;Timo <br />Fleoeived b' , (signatire) <br />nolleMion, tancling. or snipping of eanmpl�s. <br />u.€3. C Hosine (BUji A67-cg22 <br />P�{�, of <br />Project Manager <br />pnylBol info: Turn Around ire Qrilr <br />Collected by: iF_ir: and Sign} i fltc+ a <br />erne- Pressurized tly: <br />Garnpany h E-aml _ <br />P.O. #ormal <br />'Dale. <br />Addresses � City �t�S'� t �'.p <br />S £r 3S� <br />Rmj�rrtc -- <br />❑ Rush Pressuri�ai;ion -Gas_ <br />r <br />Phone L '1 °`_ 4 � `i°i Fax <br />Project tante '�70ort li rl.r' <br />N, � He <br />err <br />I Date <br />Time <br />CaPiIS.Ir!?P{;S3ttPrrlVeCltuPrl <br />66'W. Field Sample LD. {Location) <br />Can # of Colleefion <br />of Collection. Analyses Requested <br />Initial =inaf Receipt Final <br />:sir <br />Lf <br />As, <br />1,5643 <br />�i 3 I <br />DIA' <br />L , <br />RNA. <br />u <br />+`'1 <br />I,rx <br />�5}� <br />,re) Djj�: irne <br />Receivsd by: (.signanrreI <br />ramTirnn <br />:ure! Data ,, ime }. LI <br />em ivied by: (' natjr,-) <br />Cat Tuns <br />t i-2 & <br />€ 1 o / 'A <br />urt;i b4c;Timo <br />Fleoeived b' , (signatire) <br />DataTirne <br />Lim Shl pc� Marne. __ __ _,fir. Bill # :::. Ilemp (?C'i 'C�ttidifion .. Custody Sea(, In Vt�`prk•Ordor #• <br />r- _-......__.. ......---- .... : <br />Ctnly f •� Yes __.hict One I - Q <br />Farm 1293 —11 <br />