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1 " L <br /> Vlfromw .Inc. BEACON <br /> Wlran�ar <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYST=S a—/ -/ Of <br /> 15 ! � N�✓eS L�P ,t,�o,t'a <br /> Project No. v/J�(�. ' S�m�plerrJ(Signaturre) (�l Q s {, G e�S <br /> y 3 �' / [ �" YLKr� In <br /> Project Lwwion Affiliation 2 /Q4Ca QLive DA-03 <br /> (goo c4, Q L 7',q D Au ice, eh qZr <br /> sample No./lderecatlon Date Time Lab No, z° RIEMARKS <br /> X. <br /> fished by:(SignaturelA iatlan) Dal Time R Iv r pate Time <br /> Ion C <br /> Relinquished b :(Signat elAtfiliation) Date Time i . Signat /Affiliat' Date Time <br /> I <br /> Relinquis Time f eived by:(ftnature/Affiliation) Date Time <br /> 0a) Lip' <br /> Re ri q Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention: <br /> WHITE: Return to Client with Report - YELLOW:Laboratory Copy PINK:Originator Copy <br />