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ultra&r Inc. BE/�N <br /> CHAIN OF CUSTODY REPORT r <br /> lrarnw <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSI=S 3//-9¢ / of <br /> 494 �v,//.-a.,-, ��oGti�. �r <br /> Project No. Sampler(SignatI// / <br /> /17005. ID d//Z&zt� <br /> Project Location Affiliation C <br /> 21gr E lJr�.»on Sf' <br /> �� Ti'I C vl.4) <br /> _v <br /> wrs ° Sf9h�ara, T�9 � <br /> Sample No./Identification Date Time Lab No. m z° REMARKS <br /> x <br /> C--/ 3-11-74 1316— x <br /> Relinquished by: (Signature/ filiation) Date Time Received by. Date Time <br /> 0 ! � /�/�71' 1 C , 3 /-9¢ i z4 <br /> r / i S <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliati Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time Received by: (Signatur iation) D Time <br /> Report To: Bill to: ULT INC. <br /> 2^est Third Street , <br /> Hanford, CA 93230 <br /> ly/nV1 G Attention: A/, ,Egan crs <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 3280031h0 <br />