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Ultravar Inc. • <br /> CHAIN OF CUSTODY REPORT BEACON <br /> unrarnar <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> I ' ` J G{r ANALYSES 7-7—9 3 of '7 <br /> �1-d �t/n <br /> Project No 7 Sampler(Signature) <br /> Project Location Affiliation ro <br /> S <br /> /t L CO zs <br /> W 2 Z O <br /> Sample NoAdenti ication Date Time Lab No m a a z° REMARKS <br /> Nt `v3 - � 0 <br /> Ww <br /> Mw3 - 7s <br /> w 3 - $� <br /> M kv Z- <br /> Relinquished by (Signature/Alliliation) Date Time Received by (Signature/Affiliation) Date Time <br /> 7-7-?Y 1,151 <br /> Relinquished by ( ignature/Affiliation) Date Time Received b (SignaturelAffiliation) Date Time <br /> Relinquts by (Signature/Affiliation) Date Time ReWivebyig lure/Affiliation) Date Time <br /> _ A-- <br /> �0Repan To �d d r`��n m V FadRA AR INC <br /> r 525 West Third Street <br /> r`X = (7/03� ' �$ 7v Hanford, CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />