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Air <br />Sample Transportation Notice <br />ReelingAShingsignature on 'his documertin&,-xesMal MpWis 4eingsNpW it eompliancewiit <br />boal, Stale. Federal. natcriui, dud intwnAinnA laws. •egulaetions and ordinances of <br />180 BLUE RAVINE HOOD, SUITE ® <br />FOLSOM CA 95630-4719 <br />LTD.apciicable <br />L ® <br />any Idnd.Alr Toxlcs Llrrsteri ansa ws no ratility wish respect to the co lection, hardliry or shioninc <br />of mese ssrnprete <br />s. Relinquishing signature aiao indcas s�reament to hold harm.ee% defend, <br />X16} $$6-1 <br />OW FAX (91 ►) �ij Q <br />CHAIN-OF-CUSTODY RECORD <br />and indemnity Air Toxics Limitec against any cJaim, demaid, or action, of any kind, related tc ihs <br />harxlling, <br />Page. Cf <br />AIN <br />collection, 0' ah..ping of samples. D,O,T, Hatine (800; 440,7.4922 <br />f rojeGt 15RE8f'ager 3DB <br />Praje!ct Info: Turn Around <br />Lal; cwPerfv ' . <br />Cot leWed by: {!Tint and Sigr1 ,� i GfA�_ , <br />_ <br />� 'fir , <br />Time: <br />Prc�-suri7sd by: <br />_ <br />P.O. <br />ump"y sc,5 F10v "W"tt� Email _.. <br />R�Ncrrnal <br />Ddto: <br />Address 41b)�_ J UW rip' R s7�- r City Sate <=�r Zip �' project <br />C_J Rush <br />Prurization Gas; <br />Phone Fax. Project-Narnc_ <br />He <br />_ _ <br />Date Time <br />Canister PressureiVaouum <br />Lab GD. Field Sample LID. (Location) <br />Can # of Colleetien of Collection , Analyses Requested <br />Initial <br />F.nal Receipt Fi <br />TV - 1ki <br />' 3A <br />3 PGO <br />I <br />Relinquished by: l:. nnat�ure_;�Date. I inne <br />Ralingtiishad iiv_ isirgneturp; DatpjT-ne <br />-ne <br />;Lab .Sthippw Nem &' <br />Only <br />R Eu py: (sigretarel Date -Mme Metes: <br />Received: (si at.rrel DattnIme <br />Reoeivedj: (sign_ . AI QatBim . <br />TettFtp .�°C j . Conitiorti -Custody .Seal <br />No j <br />Work Order <br />IQf)1 A19 <br />Fc 12e3 w,.ii <br />