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1` �� � � • Ultfitar Inc. h <br /> bnnv �7 BE CON <br /> 6:5)D� ' CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> r-� -J ANALYSES -1 y 1i 3 of <br /> Project No. T Sample Si 9 re) J� <br /> W- o <br /> Project Locationf7 CalC�'UlCtt Affiliation <br /> N <br /> L rrc�1 Ca , GC�1 S Em q e '>l1M AJ i 14C_ x �,� o d,�-i_6_CT10AJ bl"I <br /> w = = <br /> Sam le No./Identification Date Time Lab No. ��- z REMARKS <br /> M UJ <br /> of w - 1, i <br /> 16 <br /> Relinqu' by: nature/Affiliation Date Time Receivq! b : (Signature/Affif } pate Time <br /> / <br /> Rgmq6isped. y: (S�gnature/Affiliation) ate Time Received by: (Signature/Affiliation) Date Time <br /> Relin shed by: (Signator Affil' ion) Date Time Received by: (SignaturelAffiliation) Date Time <br /> Az <br /> Re To:SNt 1l�1� I�tCHC��L� Cc�lrv� 7€i� ZIlU gill to: ULTRAMAR INC. <br /> J050r'y1G Lt>>� !.t.!, �' 11aU 525 West Third Street <br /> F,4u 7f .1,7EI 3n Hanford, CA 93230 4AJ&)t:�7?�MROSCEV �t� , CA-, `151,7[3 Attention: <br /> WHITE: Return to Client withReport <br /> JJYELLOW: Laboratory Copy PINK: Originator Copy nn 321101131. <br /> -3 ,iAi <br />