Laserfiche WebLink
u1ar Inc. 0 <br /> i= <br /> unrarnw <br /> CHAIN OF CUSTODY REPORT BEACON <br /> Beacon Station No Sampler(Print Name) ate Form NQ <br /> ANALYSES CN III-( of 1 <br /> Project No Sampler(Signa re) <br /> �°10�510 <br /> a <br /> Project Location Z�gS � ,,teary-T Affiliation 9 ., a <br /> x Co <br /> w = 2 0 SrfA�1]A�2f) "T <br /> Sample NoAdentification Date Time Lab No m z I REMARKS <br /> a -T�I.ArL Pin Q/)6 I <br /> Relinquished by (Si ature/Affiliation) Date Time Received by i a rel Date Time <br /> 114% 163, �' S <br /> Relin u sheer Si iati <br /> g Date Tim/ey/ Rec i y igna _ ate Time <br /> /�/ <br />' R I Uis b i nature/At i i i p --- � <br /> ate Time ReceivE6ignaturey A iiiation) Date Time <br /> Report To Bill to ULTRAMAR INC Y <br /> �¢Q 525 West Third Street REC ;VEC <br /> pvcv J S�4G Hanford, CA 93230 Drt,l <br /> Attention _ k ��� j eL �11lyai s <br /> i <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy i; 32 <br />