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MMMM <br /> MEMEEMM <br /> I A' tf T6XlCS For Laboratory Use Only <br /> : <br /> 180 Blue Ravine Rd . Suite B , Folsom , CA 95630 PIDWorkorder # : <br /> phone ( 800 ) 985 . 5955 ; Fax (916) 351 -8279 pagiot -� <br /> Client : d'* J /511 1) <br /> Special Instructions/ Notes <br /> ..+`„ Turnaround Time ( Rush surcharges may apply ) <br /> Project Name : Standard Rush ,. _( specify ) <br /> —.— <br /> Project Manager : - :+ . Project # Canister aimmumiPressure Requested Analyses <br /> Sampler : <br /> Site Name : Lab Use Only <br /> Start Sampling Stop Sampling = = a' _ <br /> �D amam <br /> Field Sample Identification ( Location ) Can # Flow Information information <br /> Controller # � Z JD <br /> m c w J <br /> y Date Time Date TimeLT Of– <br /> e p <br /> � - rr <br /> r <br /> r d! <br /> t <br /> LLRelln by tion )_ y- �� Date Time Rece ecl by : ( Signature/Affiliation ) Date Time <br /> Relin d b Si naturelAfighation 4 J �- - <br /> q Y ( g ) Date "rime Receiveby : {SignatuielAffifiotlon ) Dato Time <br /> Relinquished by: (Signature/Affiliation ) Date Time Received by : (Signature/Affiliation ) Date Time <br /> '. Lab Use Only <br /> Shipper Name : ( Custody Seals Intact ? Yes No one <br /> Sample Transportation Notice : Relinquishing signature on this document indicates that samples are shipped in compliance with all applicable local , State , Federal , and international laws , regulations , and ordinances of <br /> any kind . Relinquishing signature also Indicates agreement to hold harmless , defend , and indemnify Eurofins Air Toxics against any claim , demand , or action , of any kind , related to the collection , handling , of shipping of <br /> samples . D . O . T Hotline (800 ) 467 -4922 <br />