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Ultrat Ar Inc. BEk'm ' <br /> ' CHAIN OF CUSTODY REPORT <br /> unrrn�r <br /> Beacon Station No. Sampler(Print Name) D to Form No. <br /> " �, �, / ANALYSES -7 " �7 of <br /> �J V 13 -URL <br /> Project No. ampler (Signature)01 <br /> W G <br /> Project Location qo/ w - ,yl, Affiliation o ^ •'f , f- <br /> y? N �' o <br /> as <br /> w= = o <br /> Sample NoAdentification Date Time Lab No. m ►a- z REMARKS <br /> -- -�3- = -- --- - - - -- - 3 <br /> M W - <br /> 111d S <br /> Relinquished by: (Signature/Affiliation)(/� Date Time Received by: naturel�ffilial )I �f Date Time <br /> OI � l5 <br /> ReW7ci by: ature/A#' ati ) j to Time Receiv ( i na r Mai i n) Date Time <br /> e inq ish by: Si ature qt1 Wd Time Received by: (Signat iatiolh D Time <br /> Report To: Bill to: ULT A . <br /> �7) 52BMest Third Street <br /> Hanford, CA 932300 <br /> Attention: <br /> WHITE: Re rn to Client with Report YELL-OW: Laboratory Copy f'INK: Originator Copy 0280001/90 <br />