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hamar Rnio BEACON <br /> PO <br /> CHAIN OF CUSTODY REPORT <br /> c' <br /> Beacon Station No Sampler(Print Name) a Tf=orm Nq <br /> ANALYS _ I ZOf -7-- m <br /> --� r 6 <br /> Project No $arri�l 7r( n 71 <br /> re <br /> zaco <br /> Pro 1 igCa'�h _Ie.._ � l°e <br /> 't; <br /> Sam le NoJIdenti ication Dat Time Lab No REMARKS <br /> Os- 1 <br /> Q <br /> OD <br /> AWLAWL'{, P,1 __4 <br /> R 1 ui h by' nal e1A1 ation) la—te-7 Time Received by*(Signature/Afilliiation) Dale Tome <br /> CDRWVi <br /> quos ed b • S natur Aliiliation) Date Time Received by (Scgnature/ANlliation) Date Time <br /> Relinquished by (SignaturedAffiilialion) Date Time Rweiv by:(Signatur Affiliation) Date Time <br /> Bill to ULTRAMAR [NO <br /> Report o. 525 West Third Stre <br /> Hanford,CA 93230 <br /> Attention _ -- CD <br /> YELLOW Laborato Co PINK Ori rnator Co "�°°' �' <br /> WHITE.Return to Client with Report rY py 9 py <br />