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lil�Fad ' <br /> �n�—`w' •—�--- ------� BEA a <br /> CHAIN OF CUSTODY REPORT <br /> U ntra nw iIV <br /> V, .4 <br /> Beac6n Station No. Sampler(Print Name} Date Form No. <br /> ANALYSESof 2.,,.. <br /> Project No. Sampler(Signature) <br />`=. Project Location Affiliation •Q �a ! �c <br /> Y.•. ti }5'lj.•:... �V l'V\r.OYI O N 1 1- o 1 top(-- h <br /> �' U <br /> kv �� 1� 1�^' 70 h Va r�vN X v» F� � <br /> Sample Noildentification Date Time Lab No. m �a [ z° REMARKS <br /> Relinquished by: (Sic ature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> L� l67 7 <br /> Relinquished by:(Signature/Affiliation) Date Time I Received by: (SignaturelAffiliation) Dale Time <br /> Relinquished by: (SignaturelAffiliation) Date Time Received by.;(SignatGr'e/Affihatioq Date Time <br /> Report To: -j..s t �, �� ,, Sill to:' y , U11RAMAR INC. <br /> 525 West Third Street' <br /> w, Hanford, CA 93230 <br /> Attention:_ P'n M I-,M <br /> WHITE: Return to Client with Deport YELLOW: Laboratory Copy PINK: Originator Copy 328007 V" <br />