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Raja <br /> unromar Inc. BEACON <br /> ' CHAIN OF CUSTODY REPORT <br /> Beacon Station,No Sampler(Print Name) D to Form No. <br /> ANALYSES � 4 of <br /> Sampler( nature <br /> Project Nod:'} P ) J rw <br /> � m c <br /> Proje�t Location <br /> Affiliation <br /> � z o Th f <br /> Sample NoJEdentiticatron Date Time Lab No. m � REMARKS <br /> All tv <br /> 16 Pfd G <br /> Mme: t S °D11 PM <br /> � i-�0lorvm <br /> 3136 PM 2 } <br /> h <br /> 10 q1 AA1 <br /> Relinquisw bS(Sig2nalureYU <br /> iliatio Date Time Received by: NU(Signature/Affiliation) Date Time <br /> -71 <br /> Re inquished by:(Signature�ffiliation) Date Time ( ignaturelAfiiliatian) Date Time 1 <br /> � <br /> Relinquished by.(Signature[Affiliation) Date Time Received by,(Signature/Affiliation) <br /> Date Time <br /> Report To: ��' r�stc, Bill to: ULTRAMAR INC. <br /> r1 ! qC=rti Sf'- ^lies 525 West Third Street <br /> Hanford,CA 93230 <br /> a �r11 CE�, r 1 �'�wrletiLl -!n'' <br /> ,' 1 TOGS Attention: <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br /> ""A'�"° <br /> • 1 <br /> , <br /> I <br />