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- <br /> �/ CHAIN OF CUSTODY REPORT <br /> unramar - M - _ <br /> Beacon Station No. Sampler(Print Name) Date F rm No. <br /> ANALYSES of - <br /> f7 <br /> Project No. Sampler(Signature) N <br /> ff <br /> t co �)L.: SS SItvC VE'S <br /> II/V /{13 -7i Q 0 m <br /> Project Location~ Affiliation 0 c ' t� '�)vv v"`�l wyhox cruhc� <br /> chi �: '►���1� "� z° °` o <br /> LS � <br /> OR <br /> ma y <br /> W 2 2 4IL CL <br /> � <br /> Sample No./Identification Date Time Lab No. <br /> m f z°I REMARKS <br /> I 'F-- ISI e <br /> A�C-) IL Flo <br /> log <br /> LI Ao n <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) IDate Time <br />,y: Relinquished by: (Signature/Affiliation) ate Time Received by�(Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/ filiati, n l7ate Time <br /> Report To: / Bill to: ULTRAMAR INC. V <br /> 525 West Third Street <br /> Hanford, CA 93230 . <br />~:z Attention: �'t�l�t r l ��Y kJ -'5 <br /> 7S 70 <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32.60031/90 <br />