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Uffratar Inc. BEAN <br /> CHAIN OF CUSTODY REPORT <br /> nrarnar <br /> Beacon Station No. Sampler(Print Name) Date Farm No. <br /> _ ANALYSES �- 7-�%5 of <br /> ' - Loa, czalls <br /> Project No. Sampler(Signature) <br /> I >? <br /> q (,q(, - 0 1 <br /> Project Location Affiliation a "1X <br /> (n <br /> LDcA o <br /> °'�° <br /> .LD -r- A-V <br /> GS FCZ05 <br /> w = =Sa le NoAdentification Date Time Lab No. REMARKS <br /> N <br /> 3 Do <br /> i <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by:(Si nature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Relinquished by: (SignaturelAifiliation) Date Time Received by:(Signature/ ion) Date Time <br /> S � <br /> yf <br /> Report To: Bill to: ULTR <br /> 52 , st Third Street <br /> T nford, CA 93230 <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br />