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umramer hw. ' <br /> BEACON <br /> tar.nnr <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Pnrrt Name) pate Form ld <br /> {�Lt, RPO tai S S ANALYSES 101'41K I I of <br /> Prolect No Sampler(Signature) <br /> LgaoS 1 a � <br /> m c <br /> Prolecl Locaboti LI'SS Af kation y R <br /> x "= d �sS �Ao M�fl A <br /> Sawle Nollderdification Date Time Lab No IZ I REMARKS <br /> X 3 %,a JQns ua P,tE s <br /> I <br /> DATE~ 71ME D.'�j <br /> 'TEMP <br /> WEST LAB <br /> Relinquished by (S n urerAffiltabon) Date Time R i ign Date Time <br /> Relinqui Date Time '-Reeffiveld by ( ignalure(A ii Date- <br /> Date <br /> ate Date Time R Ned tgnaturelAMahon) Date Time <br /> 0 QL) Ca:)� <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention .-_ 14. T�-WLNE!S <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy _ <br />