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tl• 1+ f• t1• I• i� � I■e4tlr� �. � � � � . � � <br /> CHAIN OF CUSTODY REPORT mow <br /> Uftrarnw <br /> Beacon Station No. Sampler(Print Name) D Ie Form No. <br /> '576-L �� ,�,,,,�/�,, ANALYSES ¢ ���qs �-of 3 <br /> Project No. Sampler(Si iur <br /> Project Location / / Affiliation c , <br /> 37 /T� ^ ro�[Ct Ght / / <br /> �¢d ✓I/Oa./�cw / (�nl��?+�w7s <br /> Ac V) 0 O T�JY/l�.r ♦✓..� <br /> C <br /> Lad, CA .- v <br /> x rnv 0 <br /> w 2: 3 <br /> Sample Noildentificalion Date Time Lab No. tom- �° REMARKS <br /> z - 30 29 93 143o i I <br /> 2- 9 p 24 �'3 145-6 ♦ 1 <br /> S�- Z - 4S � 29 r7 ! Sd S <br /> 5�- 2 - So Z9 9.3 I ; rs � I <br /> s6- Y- Zo Z9Lq foo <br /> 4 z11/f-7 fS! 24 4 1� 50 1 - 1 <br /> b Si nature/Affiliation Date Time eived b Si nature/Afliliation Dale Time <br /> Relinquished Y•( g ) A Y t g ) <br /> Relinquished by: (Signature/Affiliation) Dale Time Rected by:(Signature/Affiliation) Date Time <br /> Roll' fished by: (Signature/Affilialion) D,�le Time Received by: (Signature/Alfilialion) Date Time <br /> L.l���-� t L.c�" � �����1`Z.. �� 3 //.ra 'm, -'��(��►,�,�.�� y13Ch3 11.13 <br /> Bill to: ULTRAMAR INC. <br /> At . 525 West Third Street <br /> 3�� �ac �� f�`�� �°° Hanford, CA 93230 <br /> Y-330 <br /> / Attention: 1rcA-c14 464--o � <br /> rl.,n•.X. Cir,li,/4 CEJ f S-C;.o <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br />