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_ Vlttra&r Inc. , <br /> BEAN ` <br /> CHAIN OF CUSTODY REPORT ' <br /> unr�r • <br /> .; :., .. . Beacon Station No. y Sampler(Print Name) Date Form No. - <br /> 1?19 ANALYSES ' of <br /> Project No. Sampler(Signatures) _ <br /> La <br /> Project Location Affiliation <br /> UC`�fTsvs O . <br /> W M 2 <br /> a a Sample NoJldentifiCation Daie Time Lab No. m z° REMARKS <br /> , . <br /> 3.1 <br /> VINJ <br /> fylw -q <br /> w - \ L <br /> I39 X 3 <br /> Relinquished try: (Signature/Affiliation) Date Time Received b : Sig ur ffili Date Time <br /> .' ' T /Ef <br /> ITI <br /> Reli wished by: (Signature/Affiliation) Date Time Re ived by: tore/ ffil ' H 'Dit4 YiKe <br /> Relinquished by:(Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Report To: 1,�,rJSU.+v Bill to: ULTRAMAR INC. <br /> 11Mfid 525 West Third Street <br /> til: Hanford, CA 93230 <br /> s . . Awl/ Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy 92°0071 <br />