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)Q A lJltr ar Inc. BE ON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES -S of <br /> Project No Sampler ej �,�, ''� V'L-� <br /> CD <br /> Project Location Affil son ;a <br /> Z+J-, tV, errurMA -I Aegis Environmental ° v Please use Tri-Regional <br /> w 2= o detection limits! <br /> Sample Noildentification Date Time Lab No m z REMARKS <br /> 3 �5 `i 3 ! ) yu X x <br /> Ll L -)I AL, I I <br /> L I <br /> is Ig lure/ il�atton) Date Time Received by (Signature/Afialiation) Date Time <br /> 21 _ i, ' / /-� <br /> Rehnq s ed Sig ature/Affiliation) Date Time A-eceived by ( nature/A iljation) to Time <br /> 3 <br /> Relinquished (Sig nu (Affiliation) "D6t Time— Received by (Su 60ure/AfWiation) bife Time <br /> c <br /> Report To Sheila Richgels Bill to ULTRAMAR INC <br /> Aegis Environmental 525 West Third Street <br /> 1050 Melody Lane, Ste 160 Hartford, CA 93230 <br /> Attention <br /> Roseville, CA 95678 <br /> HITE R urn to Client with � rt �f YELLOW La ora Copy �P_IYK Originator Copy +� 32800311!0 <br /> � <br /> 1Kti , �,lI /!/fT(7(' <br />