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Uftemar Inc' BEACON <br /> �1rtn■r <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No y Sampler(Print Name) Date Form No <br /> FOD cpss ANALYSES 1 of 1 <br /> Project No 11 Sampler(Signature) N <br /> Protect Lion Ztg S V, Fr'ov.,r s�. Affiliation at <br /> yM12 0 <br /> y to fi N <br /> S-Invopmo ••gyp-� <br /> Sample No Adentifrcartion Date Time Lab No m h z i REMARKS <br /> i � 1 �zf ls1 AS x } 1� -76ac.��.. A:jt t3rst <br /> � t <br /> 7-1tslJ5 xx � , 1� -V ►.a A"r, SoL <br /> k x 3 40r q %f,.ns )iGt AuiS. <br /> REIC'EIVED <br /> Ai <br /> Yt <br /> F1 <br /> IM <br /> R <br /> I [Alb <br /> Relinquishedby (S ignature/Affitratm) Bate Time Received by:(Signature/Afilration) i Date Time <br /> wk <br /> Retmquished by.(S"ture/Affil"ration) Date Time Receiv S nat e/Aftiliancn <br /> bY`( i9 ) Date Time <br /> q4e <br /> Retinq rshed by (S)6nature/Afelratron) Date Time Recenr y rgnature/Af kation) Date Trcne <br /> Report To �1 TM�-twi�or4p Bill to LTRAMAR tNC <br /> 525 West Third Street <br /> Hanford,CA 53230 <br /> Attention K m4r --E= l <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />