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o0 or-Vemn M. BEACON <br /> CHAIN OF CUSTODY REPORT 8.160 <br /> 1-7 -7q <br /> Beacon Station No Sampler(Print Name) Date t"orm No <br /> ANALYSES 17`1 Y- o 0 I 2 of <br /> Project No Sampler ure w 3 rR+�O R R <br /> Project Location Aftiln io <br /> spa k- r© �✓ o o v� ©S' 1< o <br /> x w o <br /> Sample NoAderfidication Date Time Lab No 30 m r -4 1 121 REMARKS <br /> S -- j cl- IY-00 1o :31 - '9 <br /> 11 •3 -� <br /> f vw - 3 12 . 2 <br /> 7 11 , 56 - ►L <br /> RelinquE fd ign tore/ Iration) Date Time Received by (Signature/Affiliation) Date Time <br /> �o a� <br /> el Mgnature/Affiliation) Date Time Received by (SignaturWAf kation) Date Time <br /> i <br /> Relinquished by (SEgnature/Attilfatnon) Date Time Received by (SignaturelA(tiliation) Date Time <br /> 7t1661t�,� A,- // M/5�v 1-917 <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230 <br /> I-fOR-! Z o Attention J dc Al-P 21 D G r <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />