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r r r li. r r � ter r r I. r r ��� ,�■ <br /> Unlramer Inc. BEACON <br /> CHAIN OF CUSTODY REPORT / <br /> tlitramar <br /> Beacon Station No. Sa Isr(Print N Date Form No. <br /> 474 ANALYSES 4?11-9 7 of �-- <br /> Project No. Sa pter(Sig ure <br /> La <br /> Project Locat - Aftiliatio - C <br /> N Co <br /> had <br /> 1< <br /> 6 � � r <br /> O <br /> Sample Noildentification Date Time Lab No. m CE z RE=MARKS <br /> 121/C) -- { <br /> s-3D -)W&) <br /> /z;2-25 <br /> R nquish y:(Signat e/AHiliation) Date Time RecJeiivved by:(Signature/Affiliation) Date Time <br /> 0 <br /> �--��-Relinq lshed b . Signature/Affiliation) t$e Time Received by i nature/Affiliatio ) -bat6 Time <br /> Relinquished by:(Signature/Affiliation) Date Time Rec ' ed by.(SignaturelAffiliation) Date Time <br /> Report To: T Bill 1o: ULTRAMA INC. <br /> 525 West Third Street <br /> Hanford, CA 932 <br /> Attention: ` <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy ueow "° <br />