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eurotins <br /> � a a <br /> € Air To ics - a a <br /> For Laboratory Use Only <br /> 180 Blue Ravine Rd.Suite B,Folsom,CA 95630 PID: Workorder#: <br /> Phone(800)985-5955; Fax(916)351-8279 <br /> Client: page of- <br /> OGTA't--'S SIYC.. Special€nstructionslNotes: <br /> Project Name: Avtse LSot-% (6-9ov� Turnaround Time(Rush surcharges may apply) <br /> x. pme-+ <br /> Project Managers j e Standard Rush (specify) <br /> 13 ,tkA-- Project# Zb oo�}- 'F -'100000ZU (a�• <br /> Sampler: Canister VacuumlPressure Requested Analyses <br /> Site Name: <br /> Lab Use Only 4-�` <br /> Lab vt Q cQ <br /> ID Field Sample Identification(Location) Can# Flow Start Sampling Stop Sampling �_ z J <br /> _ ti <br /> Information Information E `" q <br /> Controller# <br /> ( m 0 75 <br /> 9 <br /> �7" Date Time Date Time "c ii 0 t X <br /> . ozf' .SW�Raod� � L3Z�-r �� �� <br /> 1c 2- 3 z <br /> Rel€nq i hed ,( naturelAffiliation) <br /> Date Time R eived nature/Affi€iation) ^^/ Dat uJ ��� Time <br /> Resin i hed by;(Signatureh9knifiation) p c <br /> Date Time Received by:(5'tgnaturelAffilia ion) Date t <br /> Time <br /> Resin shed by (bignaturelAffiliation) <br /> Data time Received by:(.Signature/Affiliation) gate <br /> Time <br /> Shipper Name!! <br /> G1Se:Qy. , z . <br /> Custody Seals intact? Yes No <br /> Sample Transportation Notice: Relinquishing signature on this document indicates that samples are shi None <br /> any kind.Relinquishing signature also indicates agreement to hold harmless,defend,and indemnify Euro€ins Air Toxics against any claim,demand,or action,of any kind,related to the collection,handling,of shipping in of <br /> p pped in comp€lance with all applicable lacal,State, Federal,and international laws,regulations,and ordinances of <br /> samples.D.O,T Hotline(800)467-4922 PP 9 <br />