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,+ Unrarnar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> uma�.�ar <br /> Beacon Station No. Sampler(Print Name) QatForm No. <br /> ANALYST=S of <br /> Project No. Sampler(Signature) � aQ� <br /> Project Location Affili tion E <br /> YY-3 Eti�/rte! M <br /> w .? U <br /> SidCt� L. I JVC x 2 2 O <br /> Sample No./identification Date Time Lab No. In ir- ►a- z° REMARKS <br /> + 4tw <br /> 56 e <br /> S <br /> -131 YE I- <br /> - <br /> 1 <br /> Relinquished by: (Signature/Affiliation) Dale Time Received by: (Signature/Affiliation) Date Time <br /> Relinquish Sig ature Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> i <br /> Relinquished by: (Signature/Affiliation) Date Time received by: (Signature/Affiliation) Date Time <br /> Report To:, ice}/ &�x Bill to: LILTRAMAR INC. <br /> Sv�TE. -1 525 West Third Stree <br /> / Hanford, CA 93230 <br /> L'a�, j /4�tt SJ ��! J��2 Attention:—.--Z4& <br /> 'Z.8°°"9° <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy <br />