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I� � r � � � ! I• I• � � r � <br /> - WltralRr Inc. <br /> � <br /> CHAIN OF CUSTODY REPORT BEA N <br /> umemer <br /> Beacon Station No Sampler(Print Name) Dae Form No <br /> �it�- /a,,l zfaG -. ANALYSES �'f 'ol , <br /> Project No Sampler (Signature) <br /> 41- v- yrs y vim` <br /> Q <br /> Project Locaptio Affiliation ��' t <br /> �4 �ca L��-t y �•ht f <br /> ` W 3: :E O date <br /> Sample No/identification Date Time Lab No m � cL z S <br /> �5 4 22—g <br /> c '` <br /> � k 58 Z _ ra X320 1 tr <br /> z /z /q+ <br /> k A — 3 - 4m <br /> � Ski - 3 -6 oti <br /> Relinguished by (Signature/Affiliation) Dale Time Recei ed by (S�g atu a/Affiliation) J Date <br /> / Time <br /> IL <br /> ;f 4!00 <br /> Reim uGshed by ( tg ature/Alldiation D le Time Receive�tt (Si r li to Date Time <br /> 5 J <br /> Re q i ed ij I r E 0rate Time Recei y (Sig e/ f i is ioDade Time <br /> A <br /> p6h Tb Bill to ULT MAR INC <br /> 525 West Third Street <br /> 3 X10 �� l �t Baa �7r Hanford, CA 93230 <br /> Attention e�k�F� E�•.�s <br /> WI LITE Relurn to Cfient wilh Report YELLOW Laboratory Copy PINI( Originator Copy 32 5003 IM <br />