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+urtrrratma■ tanc. BEACO <br /> CHAIN OF CUDDY REPORT <br /> ��gg3 <br /> Beacon Station No. Sampler(Print Name) ate Form No <br /> e0IANALYSES <br /> M �� ��� .�2�i�C •a c <br /> Project No. Sampl i re <br /> fn y <br /> Project Location Affiliation 45 � <br /> f> � <br /> t-o <br /> Sam le No./ldentification Date Time Lab Na. REMARKS <br /> VW - 09 <br /> MIXI 13. <br /> � <br /> Relinquish ii !filiation <br /> 1 Date Time Received by: S' na rel ifiliation) Dale Time <br /> ©ll 1 q.3 1411 1760 <br /> R i by: ignature/Affiliation) Date Time Received by:(Signatur Affiliation) Date Time <br />� <br /> Relinquished b <br /> n4 y: (Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Report To: <br /> Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford,CA 93230 l O�r- n i <br /> 4 G��'-,fes' j� Attention: V 'A <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINI(:Originator Copy ttIM <br /> i <br /> iii <br />