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1,liitra Ir Inc. BEA N <br /> IM <br /> CHAIN OF CUSTODY REPORT <br /> Uff a"IM <br /> Beacon Station No. Sampler Print Name) Dae Form No. <br /> Sampler <br /> C z C '�l� ANALYSES S S g� of <br /> Project No. Sampler(Si nat re} 12 <br /> 46- 92 <br /> Project Location C�e.,,�ce L�k� Affiliation Q o <br /> 3S N All, �v�rrwN+ekf� 4-JU4.,� Ac • `� ._ U <br /> CA x I= o <br /> Sample No!Identification Date Time Lab No. m z REMARKS <br /> Sd- 3— ZS 4 29 1 dG+° <br /> l <br /> by WAS.T. <br /> ate O <br /> i <br /> to Time <br /> Relinq ' by:(Sig nalure/Al liliation} Date Time Received by: (Signature/Affiliation) �'� �L`r <br /> d'I0\ <br /> r Date Time <br /> l Refs wish d by: (SignalurelAll'Talion) a e Time Receive y: ignglur (filiation) <br /> Relinqui held (Signature/Affiliation) to Time R� eived by: Sigrt- relflifli' tiuttij <br /> Dat Time <br /> S <br /> R 00,To: ,. G..0�- ill ULTRAMAR I <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention: < <br /> �ac c.�e Ce„f.vt Gq 95 ;"° <br /> WHITE: Return to Cli ml with Report YELLOW: Laboratory Copy PINK:Originalor Copy <br />