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41 <br /> ultrafir Inc. 1 -' + -S <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form <br /> ANALYSES Iz-LIZI 2- 01 <br /> 615 <br /> Project No. Sampler(Signature) <br /> 9 615- 0 - �-47. <br /> Project Location Affiliation — .- <br /> N C <br /> K Q <br /> W0 <br /> Sample NoAdentification Date Time Lab No m a a z° REMARKS <br /> d <br /> Inl- <br /> 606 <br /> MV/-XS �3 g <br /> ' 7 <br /> 40 JL <br /> Relinquished by (Signature/Affiliation) Palo Time R eived by (Sig ature/Affiliafion) Date Time <br /> 22�� 61t?' &�'� I�?s A4 <br /> R q ished by ture/Affilialion) Date Time Received b .(Signalure/Affilfation) Date Time <br /> lea <br /> Relinquished b (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> h=t-- Qsla"�'�M bb 4a 3d <br /> Report To Bill to- ULTRAMA <br /> �� Ha West%IrOtreet <br /> 4—et'& Hanford, C23 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 326D03190 <br />