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• • • 1 of 1 <br /> Air <br /> aE f ° � For Laboratory Use Only <br /> PID: Workorder#: <br /> t <br /> 180 Blue Ravine Rd. Suite B, Folsom, CA 95630 Click links below to view: <br /> Canister Sam` //� Guide <br /> Phone ($00) 9$5-5955; Fax (916) 351-$279 Helium Shroud Video <br /> Client: PID: Special Instructions/Notes: Turnaround Time (Rush sur harges may apply) <br /> Project Name: Ntucoma Select TAT from drop down box <br /> Project Manager: P.O.## Canister Vacuum/Pressure quested Analyses <br /> Sampler: Lab Use Only <br /> Site Name: <br /> Start Sampling Stop Sampling = _ g' <br /> Lab Sample Identification Can # Flow Information Information ?- Z <br /> ID Controller# <br /> Date Time Date Time c <br /> El <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> 1-to- '74 _, 1 '34C /A rvii'A <br /> I M 201�-q 13'�L <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Lab Use Only <br /> Shipper Name: Custody Seals Intact? Yes No None <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 <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.T Hotline (800)467-4922 <br />