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� T <br /> lN�t`amat� � BEACON <br /> CHAIN OF CUSTODY REPORT �z6p <br /> 1-7 -7q � <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> 6 �l GC" ANALYSES <br /> f �� trt �/+n-0 <br /> Project No Sarripl Sig ur ) W <br /> Project Location Aftallbn jl.�J <br /> T`O C f'['t—O fJL OSa a NoAftdification Date Time Lab Noq-, REMARKS <br /> eAA (,V — 1.0; - KkA �1 <br /> t W_ <br /> 10 ' 17 <br /> ",g <br /> ol-,� W --7 a'•S4 � ' <br /> .3 1 H a, <br /> i <br /> Relin i e y i atu Atfiltabon) Date Time Received by (Signature/Affiliation) Date Time <br /> 1loa/-o <br /> Rel u (Sgnature/Atfiliation) Date Tree Received by (Signature/Affiliadon) Date Time <br /> Relinquished by (SgnaturatAffiliabon) Date Time Received by (Sgnature/Affitiation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA X30 r <br /> Attention �o G /f L D 2/D G t <br /> O(L I z. o r✓ <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy "'0D01A° <br />