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' Ultra&r Inc. BEAN - <br /> unnunar <br /> CHAIN OF CUSTODY REPORT � � � <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES YSES - -96 of <br /> Yl` 7 0r q In a417 <br /> Project No Sampler(Signature) <br /> I qy 0 C <br /> Project Location Affiliation <br /> Ca w� A ' . <br /> fa CbS- ort Zo �n d /bo?�c x 9-o p <br /> 0 <br /> H M a o <br /> Sample No 1ldentiTicatron Date Time Lab No m �- z REMARKS <br /> ` 0-113Ilb - MW- r-16-5L I c-) 8 x a <br /> J-of!l0 Ma- 4, -16-96 <br /> w-011r , ,rev-s' 1-16 'yb l IS <br /> w-or16 9(0 <br /> -ol��- ►^'' 3 1-16 9fO '� : 3 RECEWC-D <br /> DATEoAb&_ ' _i_55 <br /> 0 <br /> WE S <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> [L <br /> 1b�b 1_yap <br /> Relinquished by (Signature/Affiliation) D to Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affi Cation) Date Time Received by (Signature/Affiliation) Date Time <br /> i <br /> 1� <br /> Report To Bill to LILTRAMAR INC <br /> 525 West Third Str t <br /> Hanford, CA 93230 <br /> Ct 39-2 17;1, Attention &_n2V A -- <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 1280037190 <br />