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AW <br />Air <br />Sample Transportation Notice <br />Relinquishing signature on this document indicates that sample is being shipped in compliance with <br />180 BLUE RAVINE ROAD, SUITE B <br />=g <br />all applicable local, State, Federal, national, and international laws, regulations and ordinances of <br />kind. Air Toxics Limited assumes no liability with respect to the collection, handling or shipping <br />FOLSOM, CA 95630-4719 <br />985-1000 FAX (916) 985-1020 <br />® <br />any <br />Relinquishing signature also Indicates agreement to hold harmless, defend, <br />(916) <br />i <br />CHAIN -OF -CUSTODY RECORD <br />of these samples. <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 />Page _ �Of <br />Project Manager _ �r� `� <br />Project Info: <br />Turn Around <br />Time: <br />Lab Use Only ; <br />P,resspnzed by <br />Collected by: (Print andsign)1A1V,& <br />P.O. # <br />❑ Normal <br />Date'. <br />Company <br />Email `' <br />Project # <br />Rush <br />Pressurization Gas: <br />Address u1 D � -�y�� City NW6Im._State Zip <br />�8� Fax <br />��� <br />fA <br />_ <br />Project Name �"O�'Cr4l �, li <br />specify <br />N2 He <br />Phone �� <br />Date <br />Time <br />Canister <br />Pressure/Vacuum <br />Lab LD. <br />Field Sample I.D. (Location) <br />Can # <br />of Collection <br />of Collection <br />Analyses Requested <br />Initial <br />Final <br />Receipt <br />F�S�aI:< <br />Tp <br />�2"2scl <br />D Aja; <br />.AGI <br />130510 <br />iTO <br />7777704 <br />to <br />Relmquis <br />(signature ate im .� <br />Receive by: signature) D to/Tjme <br />t .� f °� (0 jr 2 its <br />Notes: <br />L �,, <br />6� <br />r , <br />Relinquishe.o by: (signature) Date/time <br />Received by: g atur) DateMme <br />J <br />(gf�1 <br />�. <br />h�'L <br />LIZ <br />Relinquished by: sig atureJ Dater e <br />Received by: (signature) Date me <br />Air Bill '# . Tslnp (°C) ,;; %:-Condition Custody Ssals Intact? Work Carder'',# <br />Shipper 9Uafne <br />Lab,, <br />Yes <br />20423 <br />a <br />Only,': <br />Form 1293 rev. 11 <br />