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1111111111110 tl� � � 11� � � � 4611111111 � <br /> ll#� mar Inc. BEACON <br /> urnwr CHAIN OF CUSTODY REPORT <br /> Beacon Station No. I Sampler(Pnrd Name) Dat Form No <br /> g ANALYSES 9 Z :,V Zof <br /> Project No Sampler(S ure) <br /> 164/ , 1,3 X161 <br /> Project Location Willarn c ro <br /> �i t ''t� yytG <br /> x <br /> 0 <br /> UJ 7: x <br /> Sam le NoJldemififi^ation Date Time Lab Na in CL a_ z° REMARKS <br /> s — s— w f g-16-97 0 9 z 9 d <br /> s'-SS —r�ccl <br /> 09 - v <br /> s—b —acv 0 .9 <br /> )0:0g C <br /> 5— 70—ni /o! Z0 <br /> W f 10!3f letf <br /> Relinquish y (S lure/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> 4&1 <br /> ejinquish y Srgnature/Affiliation) D to TimV Received by Signature/A fi-1—iationy Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Rec by (Signature/Affiliation) NMI Time <br /> �i L d:, <br /> , &1, 6'/ 7 — /V_('(- u (q11 — <br /> Report To. , J Bill if ULTRAMAR INt <br /> C7 �t,✓�L� 525 West Third Street <br /> fi Hanford, CA 93,230 <br /> p 9/& —x.39"L/72-- Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32SM IM <br />