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1 -, BEACON <br /> CHAIN OF CUSTODY REPORT <br /> 1. unra"MW <br /> Beacan Station No. Sampler(Print Name) Date Form No. <br /> v ` ANALYSES 71)-P. `i 2 of . <br /> Project No. Sampler(Signature) 0 <br /> n N <br /> Project Location Affiliation r ° <br /> v,)t <br /> / N <br /> i. .'\Y, �v cwN.ov.� 11 1 co (1) 1 t. O C.` <br /> va Q W\ o> o ,' U <br /> w <br /> Sample No./Identification Date Time Lab No. m ��- ►c- ! z° REMARKS <br /> J <br /> IL <br /> ITr <br /> Relinquished by: (Sigyature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> /3'29 <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by:,(,Sigqat0e/Affiliatiop) Dated Time <br /> Report To: �� V­ Bill to: , U RAMAR INC. <br /> 1 s l r v� <br /> 525 West Third Street' <br /> `� x�h `��•^ � �1 Hanford, CA 9/3230 <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 3290031/90 <br />