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t� Unramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT • <br /> ttiharntr <br /> .Beacon Station No. Sampler(Print Name) Date Form No. <br /> q GClaudio v,) ANALYSES of <br /> Project No. Sampler(Signature) <br /> gw�- Ct �"&" A,; <br /> Project Location Affiliation o N c <br /> 1�a'7 I�c �{ Jit/� .��pu rTR/E� ; ,, o <br /> �s <br /> WMM0 <br /> i n Date Time Lab No. m � z° <br /> Sample No./identification REMARKS <br /> ? qZ y <br /> Relinquished by: (Signature/Affiliation) Date Time WRecefveb <br /> r Date Time <br /> 1%/9L /Soo <br /> Relinquished by:(Signature/Affiliation) Date Time ignatur / filiation) Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Report To: �aX , ��� �Sl• �ro99 Bill to: 525 WesAThrdStreet <br /> %-ten zv9 5�3 -32�-� <br /> �j pq ULTRAMR INC. <br /> �vhY150� Hanford,CA 93230 <br /> 316 bold Cam &Vve, sk�klw <br /> (� Attention: &Mcf�i <br /> Rancho cctdCJv,-. , 01 <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy 324431'00 <br />