Laserfiche WebLink
e <br /> r1^71 Sample Transportation Notice <br /> ® 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 <br /> TOXICS LTD. 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-OF-CUSTODY RECORDand indemnify Air Toxics Limited against any claim,demand,or action,of any kind,related to the Page A of 1 <br /> collection,handling,or shipping of samples.D.O.T.Hotline(800)467-4922 <br /> Turn Around Lab Use Only. <br /> Project Manager 5 ,-S F Time: Pressurized <br /> Project Info: <br /> 1 by: <br /> Collected by:(Print and sign)q.AkCA A"b C �S_�- P.O.# ❑Normal <br /> Date: i <br /> Company "f7 '` ,stw� Email 5hisy125"Gi-k SCM <br /> Project# ❑Rush Pressurization Gas: <br /> Address"(f$� �h1i� ity M *� State Zip <br /> ' <br /> NHe <br /> Phone L2 7� 5" ��IJ � ICA, Fax S�v-S, `Fal Project Name �� �l}.1,�especify z <br /> Date Time Canister Pressure/Vacuum <br /> Labe>l.D.', Field Sample I.D. (Location) Can# of Collection of Collection Analyses Requested Initial Final Receipt F�6+�1;. <br /> Iq <br /> ISU <br /> NU <br /> 77777 <br /> Relinquishedtbsignatu )—Bate .ime Received by:(signature) DatelTime Notes: <br /> Relinquishe y:(signature) Date�Time Received by: i nature) DateMme <br /> 01 <br /> G191 jL <br /> Relinquished by i nature) Daterfime Received by:(signature) Date/Time <br /> ------------- <br /> Lab <br /> Shipper Name''; Air.Bill # Te,mp (°C) Coridition Custody Seals Intact? Work Order# <br /> Use Yes No one_ 2 l Q« ) , <br /> Only > ;; <br /> Form 1293 rev.11 <br />