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eurofins <br /> Air Toxicse For Laboratory <br /> PID : Workorder # : 3 d d y1 <br /> 180 Blue Ravine Rd , Suite B , Folsom , CA 95630 <br /> Phone ( 800 ) 985 . 5955 ; Fax ( 916 ) 351 -8279 page -* of - -lzlok� - F <br /> Client : WO <br /> � Special InstructilNotesTurnaround Time ( Rush surcharges may apply)Project Name � cuumtStandard Rushspecify )Protect Manag # Canister Vacuum/ Pressure Requested Analyses ` <br /> Sampler : <br /> Site Name : Lab Use Only ;.: <br /> Lab Start Sampling Stop Sampling = _ <br /> ID Field Sample Identification ( Location ) Can # Flow Information Information – a o-- z <br /> Controller # __ <br /> Date Time Date Time <br /> / — <br /> �� � P <br /> r y <br /> MoL r ! <br /> L G I '3 <br /> < r <br /> w rt c <br /> ® fr <br /> ) <br /> PRefinqedgy: ( SigQature/Mliabord <br /> on ) Date Ti e, Rt�eced bY Snaure!Affliation <br /> )2veData <br /> s Time <br /> Date Time e ( rime by : Signature p S <br /> Relinquished by: (Signature/Affiliation ) Date Time Roceived by : ( Signature/Affiliation ) Date <br /> Time <br /> Lab Use Only j <br /> Shipper Name : Custody Seals Intact ? Yes No None <br /> Sample Transportation once : Relinquishing signature on this document indicates that samples are shipped in mpiiance 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 /> f <br />