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E' urofins - � • • • � 1011 <br /> AV "( x k s For Laboratory Use Only <br /> 180 Blue Ravine Rd. Suite B, Folsom, CA 9500 PID. Workorder#: 2 A n 1 1 O 8 Click links below to view: <br /> Phone (800) 985-5955; Fax (916) 351-8279 1 V CanisterSamNyaGwde <br /> Helium Shroud Video <br /> Rush surcharges Project Name: es may Client: pID: Special Instructions/Notes: Turnaround Time apply) <br /> �., �� �a ( 9 Y PP t� <br /> Select TAT from drop down box 5A 11 1 <br /> Project Manager: t �ngi ?' I QdaAte0O # Canister Vacuum/Pressure Requested Analyses <br /> Sampler: V= h 9 Ap{c� s^ <br /> Site Name: Lab Use Only <br /> _ O <br /> Lab Start Sampling Stop Sampling = = 4+= t <br /> ID, Sample Identification Can # Flow Information Information a 0 Z. V+ <br /> Controller# "' <br /> Date Time Date Time <br /> pIA M iY i 0 <br /> 2 � �s rig � <br /> oAA W CcD6 �3't�l 8 y <br /> 3A C&A1�q zb 656 2Ll <br /> 5A _ .017 <br /> Tqld5 z <br /> 2 5Z8 <br /> OSA L 5 Z 55 gq <br /> A LiZ 1#tb Z3 bb o y <br /> Relinquished by: (Signature/Affilt on Date Time <br /> 1 Received by: (Signature/Affiliation) Da9te Time <br /> y <br /> Relinquis edby: (Sign re/Affiliation) t—IYYh+ v' aj1d 1� ,� <br /> Date Time Received by: (Signature/Affiliation) Date <br /> Time <br /> Relinquished by: (Signature/Affiliation) Date Time <br /> Received by: (Signature/Affiliation) Date Time <br /> s <br /> Shipper Name: Custod Seats intact? Lab Use Only- 3 <br /> Y Yes No None <br /> Sample Transportation Notice: Relinquishing signature on this document indicates that samples are snipped in compliance with all applicable local, State, Federal, and international laws, regulations, and x <br /> ordinances of 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, <br /> handling, of shipping of samples. D.O. Hotline(800)467-4922 (`. <br /> x <br />