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# }� tJlillra Inc. <br /> BEAC <br /> CHAIN OF CUSTODY REPORT <br /> unninar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> r !� ANALYSES i i i - of <br /> r' - <br /> Project No. _ Sampler(Signature) <br /> Project Location Affiliation -- o r i ' ) I ► ! 1 I <br /> oy = <br /> ` N p <br /> x cnv <br /> W = T o <br /> Sample No./Identification Date Time Lab No. z REMARKS <br /> I <br /> I <br /> i <br /> u <br /> i <br /> • I <br /> I <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by: (S— i re/Affiliation) Date Time Received by: (Signature/Affiliation) Dale Time <br /> Relinquished by: (Signature/Aililiation) Date Time Received by:i( ignatur�IAffiliation) Date Time <br /> Report To: to: UL AMAR INC <br /> 525 West Third Street <br /> Hanford, CA 93230 - <br /> Attention <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy-- 32-00035+90 <br />