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Ul it mar Inc. BOAC©N <br /> CHAIN OF CUSTODY REPORT <br /> Unrarnar <br /> Beacon Station No. Sampler(Print Name) D e Form No. <br /> ANALYSES r 3 •Sof •� <br /> sl LL 1 . �� <br /> Project No. Sampler(Signature) <br /> /I arm ci AT <br /> L &�z S <br /> Project Location Affiliation • <br /> Dd r a <br /> • N Q ., <br /> D-�1 im Ilu r r-comm-e X 9 <br /> w = = <br /> = <br /> Sample No./Identilicatton Date Time Lab No. m aa- z° REMARKS <br /> ,H vv-/ � 13 31 <br /> L w '�� k2a <br /> 3 7 ` 30 3 w d e r <br /> IAlaT fr <br /> 7173 <br /> Relinquished by: (Signature/Affiliation) Date Vim, Re eiv�ed by: (Signature/Affilialio ) te` Time <br /> elinq ished by: (Signature/Affiiiaii n (D le Received yr(Sigriaturialion) Date Time <br /> ` Rel'nquished y:(Signaluiel 1lillalion) Date Time Redetved IJ r- Signature/Aflillation) Date Time <br /> Report To: I Bill lo: LJLTFGAK4Afl INC. <br /> 525 West Third Street <br /> G C '� / �' Hanford, CA 93230 c <br /> Attention: -e h efiG u 0 N <br /> d <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32•6p03"° <br />