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I <br /> Amar Inc. 13AC611 <br /> CHAIN OF CUSTODY REPORT �� <br /> t�lranrlwr <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES j "' i of <br /> Project No ' Sampler(Signature) e <br /> el <br /> Project Location ! Affiliation M <br /> W = , rzo <br /> Sam le NoJidentification Date Time Lab No m 1-- �` REMARKS <br /> og <br /> Rel i wished b (Signature/Atfilialion) Date Time Received by (Signature/Affiliation) Date Time <br /> !� �'/it, 1-2 2,- <br /> Refinquis ed by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Die Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />