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lJltf iirtnar Inc. �1k ON <br /> t <br /> CHAIN OF CUSTODY REPORT <br /> unranuw <br /> Beacon Station No. Sampler(Print Name) $ to Form No. <br /> t ` t ANALYSES !/ of <br /> Pau t?. -70 Lv tS + <br /> Project No. Sampler:,(Signature) 14 <br /> /o -- .� - <br /> Project Location Affiliation = w <br /> tCLSam 1l�No./Identification Date Time Lab No. m ►°- z REMARKS <br /> r <br /> Y <br /> J; <br /> i <br /> 't. <br /> u 1 <br /> r• <br /> Relinquished by: (Sig nature/Affil iakion) Dateime Received by: SignalurelAf Ili cion) Date Time <br /> Y 3 4 � <br /> el'nquished by: (Signaturll di ion) atter Time Receive y: ignature/A iliation) Date Time <br /> 0-411 0�1 <br /> Relinquished by: (Sig nature/Affiliation) DateTime' WdKoarel i Dat Time <br /> Report To: AR INC. <br /> f 525West Third Street <br /> t)f t f 1 �A dmrCf� Hanford, CA 93230 <br /> Attention: !z e- -//I j�-- -('"Ji f 5 <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32-0003"M° <br />