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wenar Inc. E&C®N <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date Form Na. <br /> 4q¢ `//,. ANALYSES / Q( <br /> •a act L <br /> Project No. Sampler(Signature) <br /> Project Location Affiliation -- <br /> Z/ <br /> St. N N C <br /> stoc-a--to,7 6/9 hM V/ rrl ca b <br /> w z = <br /> IL a- <br /> Sam le No./Identification Date Time Lab No. m z °i REMARKS <br /> 14;v— 1 3� x X 3 4oml gogy Q1 z 4c ,��5✓ <br /> W-4 17 4-S x <br /> 1620 <br /> �y ECJ.L.5.'�'. <br /> date <br /> Relin`q/uis/h/ed by: (Signature/Afti iation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time Received by: (SignaturelAffiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) D le Time Received by: (Si nature/Affiliation) D to Time <br /> Report To: B I to: ULTRA R INC. <br /> J�m rW, For- 525 West Third Street <br /> Hanford, CA 93230 <br /> n V/ rh Attention: /—'q,-,7 e 5 t <br /> WHITE. Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 328003,N0 <br />