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unramer Inc. <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> AIS hA78 E S / of –r <br /> Project No. r"(S. Flure) IN <br /> '12 <br /> 7- <br /> i i <br /> Proecl Location W <br /> . e <br /> Affili ti ipn t12 Z; <br /> x 0 <br /> M <br /> Lu X;M <br /> ! <br /> Sample Nolidentiffcation Date Time Lab No. CL z REMARKS <br /> P- E-4 E� �I <br /> d— — �l _ — «� �_s <br /> VV, I-d <br /> -0 V1 <br /> 7 <br /> Relinquish y: (Signa f Date Time Received by:(SignaluratAffiliation) Dale Time <br /> -Re)inqtfishedi)f.-(SYgnature/Affiliation) at Time Fleceived by: (S u at Time <br /> Relinquished by: (Signature/Affiliation) Date TimeR7ived by:(Sigpature/Affiliation) Date Time— <br /> Report:To- Bilft • ULTRA R INC. <br /> C� G� p��--- 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention: <br /> 93-9 72�- <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy a2-8003 IM <br />