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UIt1'amar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) D to Form No. <br /> ANALYSES 6 of <br /> Project No. Sampler(S' tore) .21V 11,e <br /> 12 ZMVI� <br /> Project Location tion S ^ co <br /> w = = ° <br /> Sample Noildentification Date Time Lab No. m � z REMARKS <br /> Ov -o <br /> Relinquish y: (Signature/Affilialion) Date Time Received by: (Signature/Affiliation) Date Time <br /> quished by:(Signatur filiation) Date –fim—o Received by: (Signature/Affiliation) Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time R eived by: (Signature/Affiliation) Date Time <br /> 6f 11 <br /> Report To: Bill o ULTRAMAINC. <br /> 525 West Third Street <br /> Hanford, CA 9323 <br /> Attention: <br /> V-,.7, <br /> WHITE. Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 3200031M <br /> i <br />