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_ UnraAr Inc. <br /> BEAN <br /> CHAIN OF CUSTODY REPORT <br /> uttramar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSI=S L-b- 5 / of / <br /> 14 / L� <br /> Project No. Sampler(Signature) <br /> qz� 474-0 / <br /> Project Location Affiliation o <br /> m <br /> u3 = = ° <br /> Sample No./Identification Date Time Lab No. I Iz°I REMARKS <br /> MW 12-1 <br /> _ RECEIVED <br /> 1 DATEu i 16TIME <br /> MW4 S 37 <br /> INITIAL—LL— <br /> WEST. <br /> NITIALWEST LAB <br /> Relinquished by: (Signature/Affiliation) Date Time R eived by: (Si u e/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by. Signature/Affiliation) Date Time <br /> Re• quished by: i naturelAftiliation) D t Time Received by: (Signature! ation) D 7�' <br /> Time <br /> o <br /> Report To: Bill to: ULTR <br /> 525 West Third Street <br /> Hanford, CA 9323 <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32-9001f°0 <br /> I <br />