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Mrsmar Inc. <br /> BEACON <br /> CQ CHAIN OF CUSTODY REPORT <br /> 4 <br /> r- Beacon Station No Sampler(Print Name) Date Form No. <br /> °3 �9 4 A/ ��� ANALYSES <br /> s�� <br /> Project No Sampler(Signature) <br /> U I TOS <br /> Project Location Aililia0on 16 <br /> rW5 -Fj!fe MDnIsksto A M V r'n c. <br /> WZ2 0 <br /> Sample No./identificationDate Time Lab No. REMARKS <br /> -AA W- 1 - 14-1a 4L ?at <br /> z ,4 . � _ 730 1 <br /> w- 1-- vz) a All I ) l <br /> mW-1 -1 rLfo � <br /> r` <br /> ,vl tt�UV-1.- <br /> cli <br /> T . AAVJI L- rZ) <br /> A VV--L-1 a X <br /> Rellriquished 6y(SxjrrdureiAffdiation) Mr e Time Rec Signa re/Afi i 7te Time <br /> Qb <br /> R b (SgnaturetAffi1latlon} a Tuna R ived ( ig a r ff Nation) bate me <br /> v-a %1 M � <br /> Relm ui S nature/AfFli ' n) Date Time Receiv by( naturel ation) Dat Time <br /> q b ( � <br /> Report To, Bill to ULTnAMAR INC <br /> 525 West Third Street E <br /> '444'4V" Hanford,CA 93230 <br /> Rttention- <br /> `" WHITE-Return to Ghent with Report YELLOW Laboralory Copy PINK Originator Copy <br />