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.ti <br /> i <br /> uleraftl'itar Inc. BEACON <br /> CHAIN OF CUSTODY REPORTunrmnw <br /> �I�� ��;5916 <br /> f <br /> j <br /> Beacon Station No. Sampler(Print Name} Date Form No. <br /> r lrna1c � ANALYSES of 1 mm <br /> C�95 L <br /> Project No. ! Sampler(Signature) <br /> o <br /> ; <br /> Pr ect Location Affiliation <br /> co SiCKeroyee. t--�• H <br /> Of D _ <br /> xyy <br /> Sample Nolldentification Date Time Lab No. z RE=MARKS <br /> q n <br /> r W <br /> rc' <br /> 0 '7 :,51 1 k <br /> - rr I `•`vV <br /> iKJ <br /> Relinquished by:( ignalure/Affilielion) Date Time Received by:(S' nalur Alfilialion) PWe� Time <br /> Re irsqui h f,�b :(Sig nature/Affiliation) to Time Received by.(Signature/Affiliation) Date Time <br /> Relinquished.by:(Signature/Attitiation) Date Time R iv :(S' nalure/Affiliati ) _ r Dao Tirne , <br /> 1f <br /> e d TO I`�'1cLr v- ) R- l- r CKBill Eo: TRAMAR 1NC. <br /> I��G3�a0 S 525 West Third Street <br /> t�:-nv� Cons.. Hanford,CA 93230 <br /> S 3 3GT-)a3-ca. ---54� lab Attention: t� D <br /> ho C <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy u� � <br /> i <br /> ,I <br />