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Ultra&r Inc. <br /> My"Rinar <br /> BE�ON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> 6�o w ANALYSES 7-7 —9 of <br /> Protect No Sampler(Signature) <br /> Project Location Affiliation = <br /> Sfo�k-SOA /1 L/ .til o, 0 <br /> w == o <br /> Sample No/Identification Date Time Lab No � ►�— z REMARKS <br /> M W 3 -- IS 7-7-911 1; 1.�� M, X � �� 7-LI es <br /> M LA,1 3 - 2-0 <br /> 5 - zs <br /> 3 - 3 v <br /> � w 3 - -3 <br /> Mw 3 y <br /> Mw <br /> -5- <br /> Ll <br /> A4 <br /> A4 W -3 v <br /> Relinquished by (Sign tune/Affiliation) Dale Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received y (Signature/Affiliation) Date Time <br /> 7l71� � 3� <br /> Relinquish by (Signature/Affiliation) Date Time LReceWedy gna ure/Affiliation) Dale Time <br /> 710?1( ly,30 <br /> Report To /!M V Bill tAMAR INC <br /> 525 West Third Street <br /> Hanford, CA 9323 <br /> 3 7,5 7v <br /> l7 � � Attention - - <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 326003190 <br />