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FW4 w <br /> ufffrannar Inc. <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Prim Name) Date Foran No. <br /> -ANALYSESks— <br /> j4q4115 1 z of <br /> Pmjed No. saver(Signatur�e) J <br /> fit b"Lt4 a1ft*6 <br /> VDI <br /> P Locaon Affiliation .. i.� <br /> CA 1p�60k <br /> Sample Nodlderrti�cat'�on Date Time Lab No. m r-0.- rte- REMARKS <br /> Irp 3-8 <br /> 1-3 _Xx VIA I !I ks"4 ivL <br /> Q <br /> Relinquished by.(Sg ature[Affiliatiari) Date Time Deceived by:(Stmiure/Affiliation) E <br /> Time <br /> 4 44 0C Z4 C <br /> Relinquished by:(Signatyrel ffillaton) Date Time Received by:(Signature/Affiliaton) Dale Time <br /> Relinquished by:(SignaturelAffiliation) Date Time Receiv ign l at'o Date Time <br /> Report To: r)a.1t � �4,�,., Allowlf PLITOMMCING. <br /> 525 West Third StreW <br /> TA`tktkwh Va^ Hanford,CA 30 ' <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br /> PL-4 1-7 65 <br />