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' Vfframar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> 1�3' Uen�nar ,, <br /> j <br /> Beacon Station No Sampler(Print Name) x ` Date Form No <br /> s &to ANALYSES of <br /> Project No Sampler(Signature) _ <br /> Project Location Affiliation �, c <br /> p <br /> 45 U <br /> Ca- a� E �L� x z <br /> f LU22 <br /> !r Sam le NoAdentification Date Time Lab No m � rte- z° REMARKS <br /> Y <br /> - 7q. 59 �- In w 1 -q 1 z: 5 <br /> EF 5 <br /> Ell <br /> L - <br /> I <br /> � 1 <br /> Relinquished by (SignaturetAfiiliation) Date Time Received by (SignaturetAff,ltation) Date Time <br /> 3/0A <br /> Relinquished by (Sig nature/Affdiation) D to Time Received by (SignaturetAffiliation) Date Time <br /> t <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) cL Date Time <br /> Report ToBill to ULT A AR INC <br /> S c A Q�b�,,, N 525 t Third Street <br /> S s Hanford,CA 93230 7 <br /> Attention < <br /> ' WJW Return to Client with Report YELLOW Laboratory CoMV PINK Originator Copy '�° <br />