Laserfiche WebLink
6 <br /> U1fralr inca EAC N <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Dae Form No <br /> ANALYSES <br /> 1-� q l �a sen <br /> Project No Sampler(Sig ature] <br /> Tib F <br /> Project Location Affiliation c cII <br /> a� <br /> o <br /> rn o <br /> w = =cL ° <br /> Sample NoAdentiflcation Date Time Lab No m _ z° REMARKS <br /> -�- 5 6 Yl- o- -04 1 L a <br /> W /0 <br /> 60-1, <br /> Relinquish by Signature/Affiliation) Date Time Received by (Signature/Af filiation) Date Time <br /> a�a )6-3J (,vim �-zs <br /> Relinquished by (Signature/Affiliation) Date Time Recei by (Sign re/Affiliation) Date Time <br /> 1730 <br /> Relinc4ished by (Si ature/Affiliation) ate Time Received by (Signature/Affiliation) Date Time <br /> Reporf To Bill to ULTRAMAR INC <br /> 4,1,& <br /> �� J') _ Ha West Third tre t <br /> a`--�+M Hanford, CA 93 <br /> Attention L <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32 Bon`19° <br />