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fly rr IISM MM <br /> tJltlram Inc. BEAC� <br /> ' CHAIN OF CUSTODY REPORT <br /> ellrrnrnnr <br /> Beacon Station No. Sampler(Print Name) D to Porm No. <br /> 5_02 �J ANALYSES <br /> Project No. Sampler Si azure} <br /> 4a - 8(.3 <br /> Project Location Affiliation ro <br /> LtKC hC . (n m d0 <br /> V/Harei/r. �1 <br /> Lour Cq ss <br /> x _ = 1 0 <br /> Sample NoAdentitication Date Time Lab No. m - a z REMARKS <br /> gf_ <br /> /Z.7 leis f <br /> Lr ,s�eele SIG z� � ! Tap r <br /> Relinquished b • (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Io T 3 /0.'KO4 <br /> Relinquished by:(Signature/Affiliation Date Time Receiv d y:(Signature/Affilialion) Date Time <br /> Re ' quished by: (Sig., <br /> lure/ (filiation) Dale Time Received by: (SignaturelAffilialfon) Date Time <br /> L.IL•6 e``[,[.I � <br /> Report TQ. , . e ',!/ Bill to: IJLTRAMAR INC. <br /> Jcly�c �s�,.,r�tin+�n / CeAr�ffx�+4,/pec . 525 West Third Street <br /> JC& v., Svc�� °O Hanford,CA 93230 <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br /> I (Y I,,, <br />