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illy I1II� illi ■� �lllt h , I• I� I� �■ RACISM = : <br /> : <br /> CHAIN OF CUSTODY REPORT <br /> u"ramw <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES 1. of <br /> Project No. Sampler(Signature) <br /> Cn <br /> Project Location Affiliation - u, <br /> + N NO <br /> M <br /> °'D o <br /> w = = <br /> Sample Nolldentification Dale Time Lab No. m z° REMARKS <br /> w -2- b o P)- Ita <br /> f <br /> 60" 2 pD <br /> Relinquished by: (Signature/Affiliation) DateTime Received by: (Signature/Affiliation) Date Time <br /> /'''7 <br /> Relinquished by: (Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) <br /> Date Time R4ec ' ed Sig a re/Affiliation) Date Time <br /> 7 ix I <br /> Report To: Bill to: ULTRAMAR I <br /> V {„r��v �-+�" 1! ''�� 525 West Third t <br /> C.'L- Hanford, CA 93230 1 <br /> Attention: f <br /> 32tl003 f90 <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy <br />