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Munra"M <br /> Ultra aft` Inc. BEACaN <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> dQ t-d V A, ANALYSES 7 - 7- of <br /> Protect No Sampler (Signature) <br /> o Ln <br /> a� <br /> Protect Location Affiliation -- <br /> San <br /> fnt , c <br /> wzz ° <br /> CL <br /> Sample No/Identification Date Time Lab No m � zI REMARKS <br /> F,/ 0- Z-0 <br /> -"3S <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> 1P 7 <br /> Relinquished by (Signature/Alfiliation) Date Time Received by (Signature/AfldEabon) Date Time <br /> 7Y�A IM6V(� /71/y z 30 <br /> Relinquished by (Signature/Affiliation) Date Time Received b (S nature/A fd anon) Date Time <br /> Report To �a ►-own X M t/ l31il to U RAMAR INC <br /> � 7 525 West Third Street <br /> 7S D a K = �7/6) 9 3 9 Hanford, CA 93230 <br /> Attention S <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Onginator Copy 329001 1,90 <br />