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fr r r r r r r rr rr 1r r r r <br /> l�ltr�r Inc. BBA N <br /> CHAIN OF CUSTODY REPORT <br /> u�arr�ar <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES of <br /> Project No Sampler(S ture) � 11V 4 tA4AVL <br /> N <br /> 6 a °' <br /> Project Location A iation - <br /> N <br /> KIZO� u/ 4No <br /> S: o22 <br /> Sam le Noildentification Date Time Z REMARKS <br /> 3 <br /> 0 <br /> Relinquish (Signature/Affili n) Date Time Received by (Signature/Affiliat� ) <br /> DateTime <br /> ".z 0/0 <br /> mqufshed by (Signa Affiliation) Date Time Received by (Si nature/A iliat�on) Time <br /> 13yo <br /> Relinquished by (Sig nature/Affil iation) Date Time Received by (Signature/Affiliation) Date Time <br /> Srz( <br /> Report To / � Silt to ULTW T INC <br /> C7�4lL 525 West Third <br /> Ne/z Hanford, CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />