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Air Sample Transportation Notice <br />mom ® Relinquishing signature on this document indicates that sample is being shipped in compliance with 180 BLUE RAVINE ROAD, SUITE B <br />all applicable local, State, Federal, national, and international laws, regulations and ordinances of FOLSOM, CA 95630-4719 OXICS <br />a any kind. Air Toxics Limited assumes no liability with respect to the collection, handling or shipping (916) 985-1000 FAX (916) 985-1020 <br />of these samples. Relinquishing signature also indicates agreement to hold harmless, defend, <br />CHAIN -®F -CUSTODY RECORD and indemnify Air Toxics Limited against any claim, demand, or action, of any kind, related to the Page � of <br />collection, handling, or shipping of samples. D.O.T. Hotline (800) 467-4922 <br />Turn Around t_abV'se On1Y <br />Project Manager a Project Into: Time: Pressurized by. <br />Collected by: (Print and Sign) i' �` CAI -J6 ' _. <br />P.O. # ❑ Normal Date: <br />Company �'r�'�'�"� ��r Cj Email % Yn-;60'3,-j'Ait4 'al Wi•Ca <br />;t p, .� Project # ❑Rush Pressurization' Gas: <br />Address l lir-'60ICC419,1 +�` 4 � CI PU State � Zip �.�. <br />Phone C7.o`1�—ul�i lbki ax (`l1 ``�' 3`11 Project Name �Ly I%t[ C.. Speorly N2 He <br />Date Tlme Canister Pressure/Vacuum <br />Field Sample I.D. (Location) <br />Relinquished by.%ksignatui <br />Relinquished by: <br />l� T- <br />Relinquished <br />0 <br />...� <br />ure) DateMme <br />Fza'i Kl KI i' 2 l 3 r c <br />NUIERM <br />of Collection <br />of Collection <br />P <br />Analyses Requested <br />Initial Final <br />Receipt <br />Fisgi I <br />ms� <br />11 E, <br />W <br />mflG� <br />Relinquished by.%ksignatui <br />Relinquished by: <br />l� T- <br />Relinquished <br />0 <br />...� <br />ure) DateMme <br />Fza'i Kl KI i' 2 l 3 r c <br />Can # <br />of Collection <br />of Collection <br />Analyses Requested <br />Initial Final <br />Receipt <br />Fisgi I <br />41511 <br />34 LoD <br />Receivrd by: (signature) Date/Time <br />Notes: <br />r <br />! C- <br />Receiv d by: s gnature) Date/Time/ <br />77 <br />7 <br />Received by: (signature) Date/Time <br />Temp (°C) <br />Condition,' <br />Custody Seais Intact? Work"Order # <br />a t <br />YesNo one 2 ' 0 <br />^: <br />Form 1293 rev. 11 ti,. <br />