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� i � � � ■rl � r iii �i iii i�r ii � r� r <br /> Ultra or Inc. BEACON <br /> ue� CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampl (Print Name) Date Form No. <br /> ANALYSES - - 97 Z-. of <br /> Project/No. �j ler( ' ure) <br /> to <br /> Project Location I-Aftiliatic(I <br /> CL W22 � <br /> Sample Noildentification Date Time Lab No. m z REMARKS <br /> Id <br /> 5 - 0:: A)g —(-2 <br /> S 0 <br /> elinqui y: (Si ure/Affiliation) Date Time Received by:(Signature/Affiliatign) . Date Time <br /> eli ish (Signature/Affiliation} ate Time Receivedp :(Signature/Affily tion) bate Time <br /> Relinquished by: (Sii/g�nature/Affiliafion/I Date Time R ived by:(Signature/Affiliation) Date Time <br /> C f 1 <br /> Report To Bill ULTRA R INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 E-o <br /> r�Attention: 4? <br /> 7z- <br /> WHITE: <br /> yWHITE: Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br />