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uw&ar Irm. BE*Na u <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date F rm No <br /> ANALYSES i <br /> C <br /> Project No. Sampler at <br /> qS <br /> r� <br /> t,5) � �. <br /> Lo <br /> Project Location Affili ion fir <br /> �d V 1- 0 <br /> X �--- o <br /> Sa le NOJldentlf:cation Date Time Lab No z REMARKS <br /> 71L/ (4/ _to <br /> Relinquish S natu e/Af iiabon} Date Time Received by (Signature/Affiliabopl__ __ __ __ _ _ Date Time <br /> Reli ure/Affiliation) Date Time Received b (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Recewed by (Signature/Afliliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230 _ O <br /> Attention _ � <br /> r <br /> WHITE Return to Client witli Report YELLOW Laboratory Copy PINK Originator Copy <br />