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Ultrr Inc. BEAT N <br /> CHAIN OF CUSTODY REPORT <br /> ul�an�r <br /> Beacon Station No. Sam er(Print Name Date Form No. <br /> 6� , ANALYSES I of <br /> Project No. Sa ter(Sig re) <br /> Project Location _ <br /> / y7�T C r pZo c <br /> 22 0 l <br /> Sample NoAdentitication g� Date Time Lab No. a a z REMAR <br /> —17—,97 4140 —01 G Dm2 OS e <br /> IQ- <br /> R linquis by:(S' aiure/Affiliation Date Tim/ems Received by:(Signature/Affiliation Date Time <br /> 1._jt7 If , Y.--1 r.-.R,&� 'Y/XW/Jt � <br /> jz4LU& coad <br /> e1i ui by: (Signature/Affillation) Date Ti a Received by Signature/Affiliation) VU 41 15atg Time <br /> Relinquished by:(Signature/Affiliation) Date Timeeived by: (Signatur /Affiliation) Date Time <br /> i <br /> Report-To- Bill ULTRAMM INC. <br /> 525 West Third Street <br /> L/7 L Hanford, CA 93230 <br /> Y"G Attention: M✓ �.,-G-c p <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy 77-3003 Mo <br />