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Vltraar Inc. - w 4I ' <br /> BEAN � <br /> CHAIN OF CUSTODY REPORT /07-5-,5- <br /> um�mtr <br /> Beacon Station No Sampler(Pent Name) Date Form No <br /> A/crr L���T� ANALYSES I—Z I of <br /> Protect No Sampler(Signalur ) <br /> cn <br /> - 01 <br /> Project Location A iliation <br /> D C kfid n/ V L d eFyt/V. Xi � o <br /> LUMM <br /> Sample NoAdentiiication Date Time Lab No m z REMARKS <br /> 3 <br /> 3? d� <br /> Relinquished by Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> elinquis by (Signature/Affilialion) Dale Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Aildiation) Date Time <br /> Report To B 1 ULTRAM INC <br /> 525 West Third Street <br /> Hanford, CA 93230�5-�f,✓� An ,�S� <br /> /��� L14 g�m Attention JT�� <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 3240061A0 <br />