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r +` <br /> s <br /> fl9i�r i� jr Inc. <br /> ih CHAIN OF CUSTODY REPORT <br /> Form No. <br /> t�rt�en�r <br /> Beacon Station No. f Sam ler(Print Name) 1/ - ANALYSE <br /> S <br /> fH' -- <br /> Project No. CD <br /> Sampler`{S� nature) /�/ ` <br /> 2 - <br /> Project Location -- v - Atfi1i311 n -_--I o o <br /> Nom <br /> Date z REEMf Ri<S <br /> _ .7irne_ -- t-ab - <br /> JAJ <br /> Sample N'oJ1denfilication.__ _ -- - Da -- -- - J <br /> �- — Date Time <br /> Date Time Recejved by:(SignaturelAffiliation <br /> Reli i ed by:(Signature fliliation) llad �Y ~� _�_ <br /> _.�—�..._ f Dale Time <br /> YYY 5i nature/Af(ilialion) <br /> Date Time Received ia�r~aiu►elAlliliation)_- <br /> Relinquished by:( g <br /> _ Dale Tim <br /> tion) e <br /> Date Time Received by:(`�3n�re tii:iation) <br /> Relinquished by:(Sign'trelAftilia _ <br /> ULTRAMAR INC. . <br /> Report To: � � ���1Z`W 525 West Third Slrt.ol <br /> Hanford,CA 93230 - <br /> �'}, , �- <br /> Attention:_lea <br /> _ --t -- --- <br /> Q <br /> -" YGt I.k)M Latforalory Copy PINK:Crigirrator ol�y <br /> WHITE_ <br /> Return 10 Ciient with Report <br /> 1 <br /> I <br />