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Unramar Inc. BEACdaN <br /> CHAIN OF CUSTODY REPORT <br /> uetramar <br /> Beacon Station No. Sampler(Print Name) Date n Form Noor <br /> ANALYSES S' �rG of <br /> Project Na Sampler(Signature <br /> Project Location Affiliation <br /> 5 <br /> tooc�r� c ^ �7O✓'J r� riPU+�ISfr+lrA2, ! x o <br /> w = = <br /> Sample NoAdentification Date Time Lab No. F-- �- z REMARKS <br /> t �fc- <br /> G1l <br /> 1 ' <br /> 7- <br />� <br /> 30 <br /> Date Time <br /> Reli ished by (Signature/Affiliation} D to Time Received by: ignaturelAffilialion) <br /> h6 3 <br /> le 11.:5� D/3 <br /> f D to Time Received b Si naturelAffiliation Date Time <br /> Relinquished b ignature/Affiliation) y ( g <br /> Relinquished by: (Sig na#urelAffiliation) <br /> Dale Time Received by: (Signature/Affiliation) Date Time <br /> 05 <br /> N Report To:Gy42y 64te,4 f Bill to: ULTRAMAR IN <br /> 525 West Third.Str et <br /> Hanford, CA 93 4 <br /> �:3 l_,rS[.Gtr� Tz�orzdicL 'rtKc✓�t1� Sck; E <br /> 5 Attention: "!Q4z' <br /> az-eons 1190WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy <br /> 4 <br />