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Air <br />Sample Transportation Notice <br />in I AN Relinquishing signature on this document indi atesthat sample is being shipped in compliance with 180 BLUE RAVINE ROAD, SUITE B <br />10 <br />IC <br />SLT <br />all applicable local, State, Federal, national, and international laws, regulations and ordinances of <br />any kind. Air Toxics Limited assumes no liability with respect to the collection, handling or shipping FOLSOM, CA 95630-4719 <br />of these samples. Relinquishing signature also indicates agreement to hold harmless, defend, (916) 985-1000 FAX (916) 985-1020 <br />CHAIN -OF -CUSTODY RECORD and indemnify Air Toxics Limited against any claim, demand, or action, of any kind, related to the <br />collection, handling, or shipping of samples. D.O.T. Hotline (800) 467-4922 Page/ of <br />Project Manager ;j Use... <br />Project Info: Turn Around Lab orl)r <br />Collected by: Trint and Sign): > Time: Pressutized'by: <br />Company P.O. # <br />s� Email Normal .Date <br />Address O City Stat Zip Project # ❑ Rush . Pressurization Gas <br />Phone 2D9- - .?t1 Q Fax a05-,Syt. gig/ Project Name o4oc4k 11 <br />qtr N2 He . <br />Field Sample I.D. (Location) Date Time Canister PressureNacuum <br />) Can # of Collection of Collection Analyses Requested Initial ;Final Receipt: Fnaf` <br />(pat) <br />2-�-» l03t <O—L 9E 3p Ll <br />1 I <br />t <br />,.n <br />11MA fiA7 <br />F14 <br />- L <br />Relinquished by: (signature) Date�me 30 <br />Received by: (signature) DateMme Notes;:• <br />by: (signature) DateiTime <br />a ", 1J. 5y <br />-C1se.- <br />Oil1Y..: <br />by: <br />7 <br />Terttp (°C) . Corrdort CGstodj:Seals (rtairt� V1/ok Order;#, <br />Form 1293 rev, t t <br />