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r [.Ilti Amar Inc. <br /> + CHAIN OF CUSTODY REPORT B1tACDN <br /> unrai»ar <br /> Beacon Station No. Sampler(Print Name) D to F rm No. <br /> 3 Pad 2 r< f7 h D ANALYSES l 3 of <br /> Project No. Sampler(Signature) �/V-C t <br /> yv -y Jo7 °' nor'rnut -t4T <br /> Project Location Affiliation C <br /> N C <br /> til Ll a/1&1)'�J_01 1 <br /> w =2 p <br /> Sample No./Identification Dale Time Lab No. m H ti z REMARKS <br /> -8 13 63 C1 : 30 <br /> /0 <br /> ! I <br /> h. ( 1 <br /> Relinquished by: (Signature/Allilialion) Date Time Re eived by: (Signature/Affiliation) �' D e Time <br /> �J I 0"r/ <br /> eligquished by: (Signature/Atli is ion) 1 r R//le Time Received b : (Signalure/Aflilialion) Date Time <br /> Relinquish d by: (Signature/Affili lio Date Time Received y: (Signalure/Affiliallon) Dale Time <br /> Report o: i Bill lo: ULT AMAR INC. <br /> / / J 525 West Third Street <br /> 1 <br /> r� C �j G A ez h vt /-{v Hanford, CMIC12 <br /> 230 l <br /> Attention: 0 !dA )EL�-h -e-ST <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32-°�31M <br />