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Unramar Inco <br /> 13EACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANA LYSES Il'L7`�J :1.. ofd <br /> Project No Sampler(Signature) <br /> Project Location Affiliation <br /> ,r � 0 <br /> 2 Z O <br /> Sample NoAdentification Date Time Lab No m - REMARKS <br /> '2-5 ) '� � �1 I t— M <br /> D <br /> 313 <br /> i <br /> 1AW_ j0 e D <br /> Relinquished by (Signature/Affiliation) Date Time Rec!ed by r Aff a Date Time <br /> 01 no 01 <br /> Rell shed Sign a/Afi at Tim? R ed ( tur n Date Time <br /> 774 f IWAI <br /> Re! uish nat at�o ate Time Received by (SignaluretAffihation) Date Time <br /> t)S <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Str t <br /> Hanford, CA 9323 1 <br /> Attention <br /> d <br /> WHITE Return to Client with Reporl YELLOW Laboratory Copy PINK Originator Copy '�"°°"90 <br />