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r <br /> �e <br /> uit;ra.aar Inc. MACON <br /> CHAIN OF CUSTODY REPORT <br /> Urerary�r <br /> Beacon Station Na. Sampler(Print Name) _ ANALYSES D te <br /> t rofNO' <br /> LJ`�.i�• l�t,+�i�>✓,r� (,QTc i,/ }C� F <br /> Project No. Sampler(Signature) i2 Al <br /> � <br /> Project Location 'a`j-y-D . rvjf)ti N Affiliation <br /> y 11 �' o <br /> �j IlC�1��fr��r(- Z�Z -� I.�r1ULGrt1 acv U <br /> w M z 3 0 <br /> Sample No.11dentification Date Time Lab No. m r t z REMARKS <br /> SZ -2._z y <br /> 5� • 3 r3 _ <br /> X <br /> Dale Time •�� <br /> Relinquished by:(Signature/Affiliation) Date Time Rec iced by: 5ignaturelAfliliation) <br /> Dale Time <br /> Rel' uished by:(Signature/Affiliat' n) <br /> Dae Time Rece' ed by: SiSriatur f iation) <br /> ate Time <br /> Ref squish by:(Sint re/Affiliation) Date Time Recei e b naturelA tion) �f <br /> 2c,pltf Bill to: LILTRAIv1A INC. <br /> R T j 2-T OaU 525 West Third Street <br /> ('141111�71�ATt-1rL- (f�rJs�c d C7`! C Hanford,CA.93230 r!D !C�t�1�f✓N5 <br /> f`j C !f►�L'(il��" t,1L_ -k i C' Attention: `f <br /> 32 ean3 I x <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br />