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Ultrarnar Inc. BEACON <br /> ' CHAIN OF CUSTODY REPORT <br /> unran+ar <br /> Beacon Station No Sampler(Print Name) D Form No <br /> ANALYSES 1 of <br /> J19 aff / <br /> ly6l/a5� <br /> Project No Sampler(Signature) <br /> r `a W C <br /> Protect Location Aff�lia#ion <br /> �clef w <br /> w 22 O <br /> Sample No/Identification Date Time Lab No z REMARKS <br /> I� <br /> INITIA <br /> D Ela 1 IM 3 <br /> WEST LAB <br /> Relinquished by (Signature/Affiliation) DaI16 ime Recewed by atuie/Aff�l�al�on) t Time <br /> D <br /> Wbat6 Reiinquished by (Sign Affd�at�on) to Time Rece i nai re/Affdiation) Time <br /> Relinquished g re/Affiliation) ime Receiv by (Si nature/Affiliation) Date Time <br /> 7/4/� o� <br /> '::)o - <br /> Repo o r�� 525 Wes T Bill to INC <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> 0 5 q Attention <br /> Af <br /> E Return to Client with Report YELLOW Laboratory C PINK Originator Copy <br />