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Ult rar. r Inc. BEAGON <br /> PUN <br /> CHAIN OF CUSTODY REPORT <br /> Psacon Staiian No. Samplar(Print Name) Date Form No. <br /> Ilr ANALYSES of <br /> A f4 ly <br /> Project No. Sampler(Signature) <br /> Project Location Affiliation <br /> --- <br /> _ -- - - ---- --- --- x _ <br /> Sample No./Idenlificalion Date _ Time_ ._ Lab No. m F- a. z REMARKS <br /> Co - Z 1 � P(,03 �i; � /'s_Sc� <br /> �( tl I z /!�IYi. JL-J atte<7&ble w+,c�.hrx�4vxg <br /> � .z f�t.�.� �1t r�.�'l. i.'//:j/r� i✓� ��,' zl�-f - - 1 ie �f!��^ab-vlW! cs _ <br /> v <br /> Relinquished by:(Signature/Affiliatiorr) 1 Dale Time Receive (Signature/Affiliation) Date Time <br /> � <br /> C✓C�<<'crfC.: L c`'c t•r -------- �/��l. J� l 5 �OGo✓t--� �• �•lit�� "/��g� /��fil <br /> Relinquished by:(Signalure/Affiliation) Date Time Received b,Y:(Signature/Aff-liation) Date Time <br /> Relinquished by:{Signature/Affiliation} Date Time Received by:(Signuuire/Attilialion) Date Time <br /> Report To: Bill to: UTA RAMAR INC. <br /> lta;r� A/� `A/'P/.e.l rc•• s } 525 West Third Street <br /> /_ f lanford,CA 93230 <br /> C.4 ��sz Allention.- ---- �Ie+r swL/c <br /> WE IITE:Return t��Client with Aeport YFI.I.OW:L i:t,oratory Copy PINK:Originalor Copy 326°1160 — <br />