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Sample Transportation Notice <br /> ® LTD. <br /> signature on this document indicates that sample is being shipped in compliance with 180 BLUE RAVINE ROAD,SUITE B <br /> AIR AMINS ® all applicable local,state,Federal,national,and International laws,regulations and ordinances of FOLSOM,CA 95630-4719 <br /> s any kind.Air Toxics Limited assumes no liability with respect to the collection,handling or shipping (918)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 Bairn,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 /> Project Manager R,fr�, Project Info: Turn Around Lab Use Only " <br /> Time: Pressurized by <br /> Collected by:(Print and Sign)KIOLAINOfP.O.# <br /> ❑Normal Date: <br /> Company Email S}x;SSf��tZ\Ld�c�i. <br /> ti3 �tc4Spr -� Project# FJ Rush Pressurization Gas: ; <br /> Address°( `I City (NA +� State>�C Zip <br /> Phone{t��'Z� � '� v iU4' Fax Zo` 'S`iN— ' `�i Project Name rT lR speclfy N2 He <br /> 7-7 <br /> Date Time Canister Pressure/Vacuum <br /> Lab I.D. Field Sample I.D.(Location) Can# of Collection of Collection Analyses Requested Initial Final Receipt I I <br /> 311 <br /> F11 -3ad' <br /> aw-31V41 <br /> 1 "C U)i 0&73 <br /> Relinquis :(signature) D eMime Received by:(signature) Datelfime Notes: <br /> Relinqui hed by:(signature) Date/Time Received by:( i nature) Date/Time <br /> 1 nquished sig ature) DateMme Received by:(signature) DateTme " <br /> Lab a Custody 5,eals Intact? Work'Order.# <br /> Siijpper Narne• Air Bill.# Temp( C) Condition <br /> Use l� Yes' No ; one": <br /> Only <br /> Form 1293 rev.It <br />