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C <br />Sample Transportation Notice <br />Relinquishing signature on this document indicates that sample is being shipped in compliance with <br />all applicable local, State, Federal, national, and international laws, regulations and ordinances of <br />any kind. Air Toxics Umited assumes no liability with respect to the collection, handling or shipping <br />of these samples. Relinquishing signature also indicates agreement to hold harmless, defend, <br />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 <br />11 <br />180 BLUE RAVINE ROAD, SUITE B <br />FOLSOM, CA 95630-4719 <br />(916) 985-1000 FAX (916) 985-1020 <br />Page _,Z_ of R <br />Nroject Manager Project Info: <br />Collected by: (Print and sign) /�,,-Jk; C; <br />t P.O. # <br />Company6e rt cld $er✓-e S Email <br />Address �7�7��/t`�' City ,_Stay Project# <br />e� Zip 9S-.�5.� <br />Phone Fax ao-54eg-- f'391 Project Namefo®r�4%% <br />Date Time <br />Lab'LD. Field Sample E.D. (Location) Can # of Collection of Collection <br />f��Q 2•a•tb � <br />t S cr <br />Turn Around «use onry <br />Time: Pressurized by: <br />Normal Date: <br />❑ Rush Pressurization Gas: <br />veCJ•fy N2. He, <br />Canister Pressure/Vacuum <br />Analyses Requested Initial Final Receipt Final <br />tpsi) <br />��-es y� <br />r, 30 41 <br />901 <br />11 <br />l 4 l <br />Relinquished y: (signature) Date/Time <br />3 2- /6o® <br />Relinquished by: (signature) DateTme@� l <br />Re ngws ed by: s nature) Dater e <br />Re elved.by: (signaturg) Date/Time <br />Z G <br />R ceived by: i na ure) DateTme <br />61 to l7� <br />Receive by: (signature) Date/Time <br />Notes: <br />LaEk Shipper Nan ` : Alr 8111 # <br />TenTp (°C).: Condition <br />- . . Custody Seals. I <br />Work Order # <br />nly <br />On <br />9 <br />-------_. <br />_ _ _----- <br />----- <br />Yes No None <br />4 <br />-- <br />Form 1293 rev.11 <br />