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amar Inc. BR <br /> CON <br /> CHAIN OF CUSTODY REPORT XZZI <br /> Beaoon Station No. a rint Name) D Form No.1 <br /> 7 �l ANALYSES �4 9 Of <br /> ed <br /> Pr No. Sa (Signature) LA <br /> Pmoc t Location Affiliation <br /> spa c fdN o,-/z 0Aji <br /> Sample NoAdentification Date Time Lab No. RREMARKS <br /> LL) 10 I&U�9 1;00 -of 3 <br /> L'J w ) Z -Z Z `' -02 <br /> L,Aj t 6 Z. M LA-1 I I L/ (6 '-0) <br /> 5_13 57 _ n <br /> r <br /> Rel 'shed by:(Signal ffili 'on} 4DaTimeReceived by:(Signature/Affiliation) Date Time <br /> Relinquished by:(Signator A cation) im Received by:(Signature/Affiliation) Date Time <br /> Relinquished by:(Signature/Amliagon) D Received by:(Signature/A iliation) Date Time <br /> /4:e' d* tiq�27 j�/ <br /> Report To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> i Hanford,CA 93230 r /� C f� <br /> (L (� Attention: J ' �J <br /> i <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy '2'°°°'"° <br />