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uttramer Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> S Print!Name Date f=orm No.Z <br /> Sampler Beaoon Station No. { ) ANALYSES 3 -9-95 of <br /> Prajeor Sampler(Signature) <br /> Se& t.ar@ 6A.) <br /> Protect Location 16 ion N c <br /> Ca [.rte ,/i 2oN Esu s ,o a <br /> Sam la Nolldenti5cation Date Time Lab No. m z REMARKS <br /> Pt Z- C -9-9!; K <br /> I I <br /> ''i I. - C 3-9-95 ors X rs' <br /> P1 <br /> Relinquished by:(SignaturalAff�iation) <br /> Date Time Received by:(SiignaturelAffitiation) Date Time <br /> EI Date Time <br /> R fished by:(Sign turetAftliation) Date Time Received by:(Sigmture/Atfiliation) <br /> pate Time R lust b (Signature/ D to Time <br /> Relinquished by:(SignaturelAftiiiation) � � x � <br /> h�,-j�,�I I <br /> Report To: R,G� Bill to: ULTRAMAR INC. <br /> 525 West Third Sireel <br /> uit,) X38-ZDSS Hanford,CA 93230 <br /> RK (9 rt+) (038 -838 Attention:_re 1!4& <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy t'INK:Originator Copy <br />