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unranOlne. BEAC& <br /> qu,�'amw CHAIN OF CUSTODY REPORT <br /> Beacon Slalion No. Sampler(print Name D le Form No. <br /> / /� l � ANALYSES y� �� l9 4 Z of 2- <br /> 4 4 16 / a L c.. c./ <br /> Project No. Sampler( n r `CCSLL G �c <br /> Project Location Affiliation / <br /> Z4f� LJ. 't 6af� 1j4x7��' m ° �cr-1lir 7,Cf A. <br /> C4 <br /> wT = <br /> Sample No./Identification Date Time Lab No. h z REMARKS <br /> Cry — 3 — 4S 2 ti 4 ` o 2 XX i <br /> Relic Ji by: (Sig alur /Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> _�__ �4� /2 sr 19 -2j [49, iz=z3 <br /> flelinrl�iislQ by: (Signature/Affiliation) Date <br /> Time Receiv d by: (Sig lure/Affiliation) Dale Time <br /> Ah <br /> _� <br /> F;elinct <br /> -is by: ( ignalurelAlfilialion) Date Time Received by: yS' ure/Affilia' Dale Time <br /> f3eparl To: ,���-�•-� c,r � r� ` ill to: ULTRAMA C. <br /> 1r r 525 West Third Street <br /> Hanford, CA 9323 <br /> ��� ltiv� .dam, f„�/` !°o <br /> 3 <br /> �/// //11 Allenlion: L�N""' <br /> /?Z,CA e. .e 4 SZ T's <br /> 3260031190 <br /> WI IITF: Relurn to Client wilh Report YELLOW: Laboratory Copy PINK: Originator Copy <br />