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0 ' F <br /> uJLW IM. <br /> K971 BEACON <br /> CHAIN OF CUSTODY REPORT <br /> tlaetrrr <br /> Beacon Station No Sampler(Print Name) D to No <br /> ANALYSES 5� - iimof <br /> Protect No <br /> /� O Sampler �gn fi t�N �t2 <br /> cl q _ y .� <br /> Proojec t Location Affiliation w 1 T r <br /> S�oG 'fiQ '40 lJL 0 <br /> o <br /> Sample NoAdentification Date Time Lab No a z°I REMARKS <br /> PM u/ 2 &71 X0 15 —C-�ON <br /> I <br /> I <br /> Rehnqub S re/Affiliation) Date Time Received b (S aturel ffiliation) ate Time <br /> ;r°l r7� <br /> ish y Scgnature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by.(Signature/Aifiliation) Date Time Received by (Signature/Afldiation) Date Time <br /> I <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230�1�� �LD21��� <br /> 6e�P-lz � 6 ft ICE Attention 1 <br /> WHITE Retum to Client with Report YELLOW,Laboratory Copy PINK Originator Copy <br />