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Vltrr Inc. <br /> BEAC4114 <br /> lrirarner <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Dat Form arm No <br /> ' ANALYSES l 6_� / of <br /> �'An <br /> Project No Sampler(Signature) <br /> Project Location Affiliation c <br /> N N CO <br /> WZ2 <br /> Sample No/Identification e Time Lab No m � z <br /> DatREMARKS <br /> HItiN-1-t F06 <br /> Relinquished by (Signature/Affiliation) Date Time F19ceived by (Stur ffiliation) Date Time <br /> ,2 fa <br /> (tl(64 flea <br /> Relinquished by (Signature/ t Time Received y. ( gnature/Affiliation) Date Time <br /> Re cashedWbnature/Affiliation) a Time Received by (Signatur tion) D Time <br /> rr!� 6�5� /d [, /Z t l BGG A <br /> Report To Bill to U / <br /> 5 West Third Street <br /> r Hanford, CA 93230 <br /> ✓� l Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 324M M <br />