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�, Ultram nc. BEACy.- <br /> unm aCHAlN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) <br /> �j WtjjFarm No�� �,' �� �y�/?GANALYSES �. of <br /> protect No of <br /> (Signature) <br /> Protect Location Affiliation c <br /> I <br /> o c <br /> w = = o <br /> Sample No/identification / Dale Time Lab No io— I'_ ° <br /> z REMARKS <br /> 1 5 .2// 1 z ,1,3 .3 <br /> L,5 - 3.5 <br /> 7 55f <br /> 13 , _30 <br /> i <br /> Reuished by (SignaturelAffilial ion) D to Time Received by (Signature/Affiliation) Date Time <br /> &Relinquished <br /> by Si na a ffi jQn) ai -Time R � ti /YLv <br /> ec rued by ( igr at re/AffihaUon) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time ec ved by g gnature/ fit ion) <br /> ADD,,atTrme <br /> Report To - <br /> S ULT AM tNC - <br /> 525 West Third Street <br /> [ f Hanford, CA 93230 date��// + <br /> Attention Ert 6 !r' _ <br /> Wt LITE Return to Client with Report YELLOW Laboralory Copy BINK Originator Copy <br /> 32 9003 1190 <br />