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unranbinc. BE=GW <br /> CHAIN OF CUSTODY REPORT <br /> �r <br /> Beacon Station No Sampler(Print Name) _D�t o No. <br /> b Lf /-1q 1 I_ e7 ANALYSES <br /> Project No Sampler(Signature) <br /> q -6 1/ / <br /> Project Location Affiliation <br /> Sample NoAdentillcation Date Time Lab No. z REMARKS <br /> v W-)- 6 1. Z X <br /> rnw. G /-1, --03 X <br /> 713 _ 6 X <br /> M w 743 -z <br /> Relinquished by (Signature/Affiliation) Date Time Received by-(Signature/Affiliation) Date Time yJ <br /> Relinquished by (SignaturetAffiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) I 'late Time <br /> e �s <br /> Report To Bill to ULTRAMAR INC <br /> v� 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy "'0 3140 <br />