46
<br /> I I 1 I I' I 1 I ! ' i I I '
<br /> i 'I Ultramar .nc. .:F
<br /> `I
<br /> BEAC®N
<br /> gmmnw(
<br /> „ , ITiCHIAIN OF'CUSTODY=REPOFIT a ” ' :;E ;!'t 'i ..z: F'{ i :1141
<br /> ,+ I I
<br /> Beacon Station No. I'"I+ Sampler(Print Name). I 1. ' is►, "fl l r >I D"ate ` '4 I' ,Form No: f} I
<br /> l , - ,11 1� i; I I r'f' , QII
<br /> I I I r,.t c� ail l� II I 11 -1 .}
<br /> r. ANALYSES oft i .I,
<br /> Pofect No i Sampler(Signature) i 1 '�,;, 'T'A
<br /> I
<br /> .1 1. I'�ry`' "�'i'."". ql �i'� I I �,� �I ` i „/ i_.s• Ili,}i I.
<br /> P'ro ect.Location I Affihatlon a ;l ;c `Q :,:---• ; 1 I
<br /> E yj. I-I .,1� L1 II.I ' ; �1. {�(ql' iA+�l` �,, I, j i ,I I _ '?, CQ ITC�T>;. +��+
<br /> I i I I I Ol✓� 1�—I'�Q1 I .'l 1 ES. V� �, I i ' �I
<br /> P 4
<br /> ,.. I i a
<br /> w'='=
<br /> 1= Fes,L]!' l'�, .7 ,i 10
<br /> I Sam le No./Identification, Date: a Time I�ab'No''i m F- P'l , 1- z ! REMARKS I,
<br /> .I� � ;"fl:'r�+''. I +III 'll" ..I�•I I 1 I�'I} , iLI' I ,. ,nl�_ ;' r,,, Sh,i,�1 (i( �. I. .+, ; !4 �`
<br />� i ! � i.. III°.1 1 ,I 1 i1 "'I, i' I + {� � ' �;, r•� �.i �{ �I'� I I I� � I ��� I T'• � � �' e �r1i .i l','E. .� }}� ., �1�
<br /> :. . ` ..
<br /> + ,'i"' II• '.. , ,j p'II1 �' ,�'.. ." '�I ISI ,i .i�1 a i ,I. I,. a. I ,I �i: p ,#1 { i'
<br /> I'
<br /> ,.�.'I111'0 .� .� - ' ,I'I: �+ '• !;''""A.,,I �/ {,''1 III I ul ; 1 Ir, .
<br /> ��-iiiii//
<br /> f I �i L. ' rt •.r
<br /> .I,'I
<br /> _ 1 I
<br /> I�
<br /> I„I I r , I
<br /> I.. 'j ,I' i I.+ II I 'I� ,. j, 'i. � I '� t,'• :I, .I y � , � .II I 'I I !I 11.
<br /> ' i l „`I
<br /> Relmryuislied b ''Si nature/Affiliation I ,'Date) Time'. iR a e/Affiliation Date Time
<br /> % M, M! I , i, l I 1 1,.;1 r. ,I +• , I I,LEII� l n 'I .€ �,1� 1 � I,I ; ?.! II
<br /> U
<br /> Rel Is d'b lure/Affiliation) Date;rl Time'I S' r 1 io D e Time '
<br /> r { i
<br /> I ,
<br /> A li i n) D to Tim ih n) Date :Time
<br /> a byi (Signature! ff at o , e eive by: ignaiure/A j' I
<br /> € � ' .1 , ' ' I .'I 'I. :'I �it r � ' � , .•I .,
<br /> ,
<br /> i Report To: I I Bill to: ULTRAMAR INC:"
<br /> !� j
<br /> t25WI Third StVeet,,
<br /> i Hanford CA 93230
<br /> 'Attention:
<br /> aA i n:
<br /> - , 1 J ,
<br /> I
<br /> r: II
<br /> WHITE Reti4ffi'io'Clientwith Report YELLOW: L'aborato'ry'Copy. RINK Orlgi atorCopy. 3 °°°"W ! • I
<br />
|