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-4 <br /> r <br /> U tsar Inc. BOH <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sample27r Name) Date Form No <br /> t ZOq ANALYSES ��+q- vp of Z <br /> Project No Sampler ignature) <br /> ( q19 La <br /> Project location Affiliation <br /> x V� <br /> -- a <br /> w <br /> Sa Noildentffication Date Time Lab No m (` z REMARKS <br /> A <br /> w p5'rg — MLJ IL <br /> k <br /> ft <br /> Relinquis by (Signature/Affilt ton) Date Time Received by (Signature/Affiliation) Date Time <br /> uY�tzc <br /> Relinquts ed by (S�gnature/AfiI tion) Date Time Received by (S,gnature/AffdiaUon) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) , 1 Date Time <br /> Report To Bill to#-- AR INC/ <br /> 525 West <br /> Z o r Th rd Street <br /> Hanford, CA 93230 I 1 Iz <br /> AttentionL--6 <br /> u sow M <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />