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4 � 11'169 •. <br /> UMMMOr • BEACON <br /> CHAIN OF CUSTODY REPORT <br /> ull�.ewir <br /> 8&'icon Station No. Sampler(Print Name) Date Farm No. <br /> ` ANALYSES of <br /> 6 n <br /> pFOed NO. Sampler{Signalure) <br /> Affiliation <br /> f ' <br /> "ad Location 2 � � � ��' � <br /> <4A 4'w..q 1 L4j" XSE <br /> Samole NoAdentiication Date Time Lab No. VVREIVARKS <br /> m w 1 - 12A 5 <br /> 35 <br /> .� 3 <br /> �. OL <br /> �IL <br /> r.. <br /> Relinquished by:(SigMure/AKliation) Dale Time Received by:(Sipnature/Miation) Date Time <br /> I'd 4PLIV,6j- &" �6'I'l' 9_90&V_X_ !�4= )wC6r( <br /> QiWisW by: ignature+Affilidon) Date Time Receiv by:(Sign relAffik tion) Date Time <br /> Rol' uished b .(Signature/Affiliation) Date Time ReceivedrelAffilialion) Date Time <br /> natts <br /> vut�L F(16A <br /> Repori To: Bill to: &TIMMAR INC. <br /> q, 525 West Tturd Strew <br /> Hanford,CA 93234 <br /> ( q ( 4 ) 7M ~ 12 -77 <br /> Attention: <br /> WHITE: Retum 10 Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br /> i <br />