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r r , r r t t r r r t r y r r r r r <br /> Ultram wk Inc. BEAC:�.N <br /> F �! 3 CHAIN OF CUSTODY REPORT <br /> unr <br /> ,:�.• <br /> aner <br /> Beacon Station No. Sampler(Print Name) 0 Date Form No. <br /> ANALYSES 2 2c� 9'L of <br /> Project o. Sampler(Signare� <br /> I 0z " 0 E,> (,r; <br /> Project Location Affiliation <br /> � N N �' W o <br /> Ary 7e,c A P-zsN/ _�_�° <br /> a <br /> z <br /> Sample No./identification Date Time Lab No. m ra- 1, �+� REMARKS <br /> W-z q,mw y <br /> w. ,q,Mwq Cc,.)rHcLa 42-TL <br /> VVZq-mvj � L cTy,2 2-•Z6'�2 <br /> W-Z•5 ,Mt,J 3 k,&5Ar t-)!� 3 t S l <br /> W-'ZS ,M w Ct )r kc t,) 13 : /5 <br /> 3 <br /> fir/-Z5_ W3 cwr�+cr � l3: 15 <br /> Relinquish b : (Si at re/Affiliationea•i Date Time Received by: (Signature/Affiliation) Date Time <br /> z . <br /> Relinquished by: (Sig naturelAffiliation) Date Time Re ed by: (Sign ure/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by-,(Signature/Affiliation) to Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 �.- <br /> •�C�L Attention: <br /> az-eouai M <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originalor Copy <br />