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------------- ............ ............................ <br /> Sample Transportation Notice <br /> Air Relinquishing signature on this document indicates that sample is being shipped In compliance with 180 BLUE RAVINE ROAD,SUITE B <br /> LTDall applicable local,State,Federal,national,and international laws,regulations and ordinances of FOLSOM,CA 95630-4719 <br /> ® 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 RECORD and Indemnify Air Toxics Limited against any claim,demand,or action,of any kind,related to the Page of L— <br /> collection,handling,or shipping of samples.D.O.T.Hollins(800)467-4922 <br /> . : <br /> Project Manager _S-�- ac< Project Info: Turn Around (ab,Use only <br /> Time: Pressurized by: <br /> Y, <br /> Collected by:(print and Sign) AW.Lgi I_JHe_AV <br /> P.O.# 1:3 Normal <br /> Company 4'�^t4 t-615 Email <br /> Project# ❑ Rush <br /> Address -117-fn 4),: ity Acz___� -Statee-,AZIP23xz <br /> del <br /> Phone 76 c? S­okS'-?Y,9 Project Name speckv NHe <br /> Fax ZO 9 2 <br /> Date Time Canister Pressure/Vacuum <br /> Lab' Field Sample I.D.(Location) Can# of Collection of Collection Analyses Requested Initial Final Receipt iFln,g <br /> IV <br /> Ire <br /> 7 -F7 <br /> 77 <br /> 4-ZJ IL7 <br /> ?4 <br /> J/ <br /> 'Yo <br /> xzl L7 -77 AI— <br /> _X-) <br /> 777 <br /> Relinquished by:(signature) Date/Time Received by:(signature) Date/Time Notes: <br /> ro Z!0e) <br /> 01&:00 iA44A1Ae1bd1�4 "11's <br /> Relinquished by: (signature) Date/Time Received onatu 9) Date/Time <br /> a <br /> Relinquished by:"ignat-ure) Date/Time Received y: ature) Date/Time <br /> Nature P ,gnditiQ Gjstoo. <br /> Seals intact' <br /> Wdrk.n Order <br /> 4 <br /> V 4 <br /> Use <br /> Ova r re <br /> Qnly <br /> Form 1293 fay.11 <br /> Ali <br />