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u ar Inc. 1 A81 <br /> B ' <br /> CHAIN OF CUSTODY REPORT c�,G�o7JU <br /> �ilrrnr / <br /> Beacon Station No Sampler(Pnnt Name) Dates Form No <br /> -/ ` � A AL S S C' `-� of <br /> v r �i��C� <br /> Project No Sampf SCc <br /> Project Location Aff lj ion -�1 <br /> w o <br /> Sam fe NoAdentifrcation Date Time Lab No m a z i,tMARKS <br /> 31 <br /> air w <br /> /dam w - 6 3 ~3� -vim <br /> w - 3 3 - 10 �7 <br /> � -off - - --- <br /> Rehnquishe ( gnat re/Affll tion) Date Time Received by (Signature/Affiliation) i Date Time <br /> Reis ed (Sign ture/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affdiation) �i + Date Time <br /> ---------- 01 7d41-k111&'&0z woo <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230 Attention� J �- L'19 <br /> /Z. � 71j�/ <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 324003 IM <br />