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Vltroar Inc. BEAN <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No S er(Print Name a Form No / <br /> ANALYSES � of 1. <br /> �a Iv�lSAjw<qs�' <br /> Project No S er(Signature) <br /> 16qls / ZP <br /> Project Location Affiliation <br /> N <br /> s 1�-�p►� a d �v r N C_ x2S 16 <br /> Sa le NoAdentification Date Time Lab No m z REMARKS <br /> E LA) -65Sq 1J f` -ZS : 70 <br /> _ a <br /> t w-- aS2l - ttir 3 d o <br /> R cashed by (Sign A fi tion) Date Time Received by*(Signature/Affiliation) Date Time <br /> Relinquished by (Signat re/Affiliation) Date Time Rhceivedby (Signature/Affiliation) Date Time <br /> Rghnquished by (Signature/Affiliation) Date Time Rec ived by.(Signature/Affiliation) �Date Time <br /> Report To EF to UL AMAR INC <br /> 525 West Third Street Hanford,CA 93230 �L�ktk6�.K_G � a��5iv� Attentson <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy Z"M I"° <br />