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S euPOfIY15 ' • • KAMP • Instructions <br /> Air Toxics <br /> Ne <br /> Eurotins Environment Testing Northern California,LLC180 Blue Ravine Rd.Suite B,Folsom,CA 95630 �1n '1 /1 Workorder#-, 2171 ,0 <br /> Phone(800)9855955; Fan(916)351-8279 y page.._ of <br /> Client. �Qyi ,„ Turnaround Time(Specify Below) h <br /> Project Name: ( t. d Y W / t <br /> Standard Rush__(Surcharges will apply.per availability) <br /> 1,..- ti Site Name Q (jtjMyy P�Q-t rr. sr mia:re�.en anereara esr Requested Date(min/ddlyy): <br /> {`�� Project#: e:dweemoe reeervea on <br /> 1 Manager: IC)a4 it US dPh" fe ine miwwopwrtuay 4B Number of Days: <br /> Project Mana er <br /> Requested Analyses Canister Vacuum(Pressure q <br /> PO#: <br /> Sampler: Q „4 V^ Lab Use Only <br /> on <br /> u <br /> .Lab Start Sampling Stop Sampling Z Field Sample Identification Location Canlaler Flow controller information ID p ( ) earcotle# Information e _ E c N . <br /> Barcoae# <br /> m = <br /> Data I Time at <br /> X 7P � w <br /> - G 1 MOLT 6 2. �c <br /> 0 2 Z )c <br /> �/-A o a I p <br /> VN- t y3 a m- r( <br /> v y-L I L3+ 2 52 45z3 G X <br /> ILl 67- 2sta( 113 1(Nh K <br /> 124 X X <br /> 1)5 - C ILI(o3 qlq <br /> ` � IluLtll I401 1C ', <br /> J -G �L3 Z z. 1uW1 q{ ; x 143B- <br /> Special lnstructionslNotes: <br /> Y <br /> Relinquis NrelAf611ation) . <br /> Date Time Reosh, by:(S' at re/AffiIhimn) Date <br /> Time <br /> U-(-1 1a ,2✓ s � <br /> Relinquished by:(Signature/AffJialion) Date Time R 0 .(Signature/AflJlation) Data `I <br /> Time ..:.;: <br /> RaGnquishetl by:(SlgnoWnsAmnation) Dete Tlma Received by:(SfgneturelAftlOation) <br /> Dale Time <br /> Shipp Lab Use On ,r. <br /> er Name. ! Custody Seals Intact? Yea No None 1' Condition: .... <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 any kind Relinquishing I <br /> signature also indicates agreement to hold harmless,defend,and indemnify Eurofns Air Toxics against any claim,demand,or action,of any kind,related to the collection,handling,of shipping of samples.D.QT Hotline(800)4673922 g <br />