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Uwamar Inc, BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Statbn�lNo. Samplar(Print Name) Date Form No. <br /> 7�'4- �f�� DlG' �� ANALYSES of <br /> p(oad No. Sampler(Sbnature) <br /> m <br /> Location Affiliation <br /> .Z f S" <br /> 5>✓G�/�c to.7 Gr9 14 AI VI X'n G . 0 <br /> w E a St�rlda--d /wr . <br /> Sam a Noildent'dication Date Time Lab No. ~ REMARKS <br /> w~Z / Id 1xi 41 <br /> A?w-3 <br /> S 3 <br /> Mw-4- l74 <br /> by .r.G .1� <br /> data <br /> Relinquished by:(SignatureiAffi iation) Date Time Received by:(Signature►Afiiliation) Date Time <br /> .G� 1� <br /> Relinquished by:(SignaturWMation) Date Time Received by:(SignatureMiliation) Date Time <br /> = rr. y <br /> Relinquished by:(S]gnMureJAffdladon) 4AG, Time Received by:(S rtatur Aflilial'ion) d " Time <br /> L <br /> Report To: 8 I to; ULTRAVIAR INC. <br /> err riv. 525 West Third Street <br /> Hanford,CA 93230�+ <br /> /4MVj Attention &. <br /> WHITE:Return to Client with Repan YELLOW:Laboratory Copy PINK.Originator Copy �+� � <br />