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ot <br /> :::: e u rof i ns JKR[FPJRM instructions } <br /> Air Toxics <br /> ❑, ❑ <br /> Eurotins Environment Testing Northern California,LLC <br /> 180 Blue Ravine Rd.Suite ( Folsom,CA 95630 Workorder#. ^7' f �.0 E• r t <br /> Phone(800)9855955; Fax{916(351.8279 t—,j LT <br /> page� of <br /> ClienC Turnaround Time Site Name: Standard 3 <br /> Project Name: a Specify Below) <br /> S <br /> �xrLtu� Y �j Rush (Surcharges will apply,peravallabllty) i <br /> � <br /> sam es receheaaseroPuesT Requested Date{min/tldlyy): E <br /> Project#: s aeree m be,reryee oe <br /> e me Id. wwi�ue. i <br /> Project Manager: V ` "a v OB Number of Days. {' <br /> Requested Analyses Canister VacuumlPressure 3 <br /> Sampler: ;✓ PO#: ( .. <br /> Lab Use Only i <br /> Leh Start Sampling ao <br /> 10 Field Sample Identification(Location) Canister Flow redo norInformation <br /> i g Stop Sampling = s ^fir z <br /> Bamotle# 1^formation <br /> Barootle# Information <br /> be <br /> cZ <br /> m m �S <br /> Data Time Date Time u. C e Sto <br /> 1 L.N3s'1 'Z. - P-z3 P3 10-i1-Z3 t 7� 7C i <br /> �i <br /> r < <br /> Y <br /> l <br /> { <br /> Special lnstraIXlons/Notes' <br /> e <br /> Relmqul y:(S net filiation) 2 <br /> Date Tlme Received y:(Slgnatur/Afli1.on) ) <br /> Date Time <br /> Refn fished by:(Signature/Affiliation) �� � -7 -7 w ¢ f <br /> Date Time Rece ed by:(3 store/ it ion) d�a x <br /> Date Time e <br /> Relinquished by:(Signature/Affiliation) f <br /> Date Time Received by:(Slgnafure/Afryliation) b, <br /> Date Time <br /> 1 <br /> Shipper Nama, / Lab Use Only <br /> Custody Seals Igtact7 yes � : <br /> sit No :. None �ondi8on: ': . <br /> Sample Transportation Notice: Relinquishing signature on this document indicates that samples are shipped m compliance with all applicable local,State,Federal and international Ism <br /> of'shipping <br /> and ordinances of any kind.RehngRelinquishing,Relinquishing, t <br /> signature also indicates agreement to hold harmless,defend,and indemnify Eurofins Air Teem against any claim,demand,crabber,of any kind,related to the collection,handling,9 Aping of samples.D.QT Hotline of <br /> (Sin)4874922 <br />