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IJIt _..tear Inc.._ <br /> CHAIN OF CUSTODY REPORT <br /> iLi <br /> Beacon Station No. Sampler(Print Name) 1 Date Form No. <br /> ANALYSES 2—Je off <br /> Project No. Sampler(Signature) <br /> 7- <br /> Project Location Affiliation 6 0 <br /> th 0 9A <br /> M A? 0 <br /> _x 0,0 <br /> w M <br /> a. a- 0 <br /> Sample No./Identification Date Time Lab No. �_ z REMARKS <br /> Ai <br /> v/- 1A 1 131 <br /> -z <br /> ri <br /> 74 <br /> '7 <br /> V <br /> Relinquished by:(Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Re1i?iq`uisK&6y: (Signature/Affiliation) Date Time-1 Received by:(Sign(Signature/Affiliation) Dale Time <br /> Relinquished by: (Signature/Affiliation) Date Time Rece' ed by:(Signature/Aff ifiation) Date Time <br /> �jv 31 <br /> Report To: Bill to:. ; ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford.CA 93230 <br /> AII-Ontion : <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br />