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UnqWar Inc. BEJ&N <br /> CHAIN OTODY REPORT <br /> Beacon Station No. „ Sampler(Print Name) 1 Date Form No. <br /> ANALYSES 0 of <br /> `,� <br /> Project No. q - Sampler igna r y fid *L-,lq a <br /> co L � Ll 01 _ <br /> Affiliation <br /> Project Location .. <br /> a <br /> Z <br /> x = o <br /> Sample Noildentification Date Time Lab No. m a i REMARKS <br /> —03 <br /> ,Oy <br /> — G 1 ( - 57 o� <br /> M tA.- — 7 � :�� --06 <br /> ` p7 <br /> Relinq ' a re/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> c�L0 <br /> Rfoliation) Date Time Received b .(Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> i 525 West Third Street <br /> Hanford,CA 93230 yC9 67 <br /> Attention: U <br /> Y <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy 32-6M MO <br /> I, <br />