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� wi■�■ ��w ■� � � t! � t! t! t! li>• � � <br /> Uror Inc. BE CON <br /> CHAIN OF CUSTODY REPORT �`rf <br /> Beacon Station No. Sampler(Print Name) Date Form No <br /> 419 ANALYSES 1.3 of <br /> i <br /> Project No Sam er(Sign re) <br /> 19, 12— <br /> Project <br /> Locationi IRE <br /> 0 <br /> Sam9e Noildentification Date Time Lab No Co z REMARKS <br /> rn r 7' z8 <br /> 7. s r <br /> �2- J / 'S/ <br /> Sr ;vSI N - n <br /> P +0 I <br /> r S O"/z—Ajw 8A. - o <br /> 05, <br /> J1Y7'elinq6iN <br /> yAiganature/Aftil6tion) <br /> Affliatio�� <br /> Date Time }Recewed by (Signature/Afih t e Time <br /> Date Time Received by (SignatureiAf n Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Recewyd by JSignaluWAffdaalion) Date Time <br /> + , /J'oi-wt klz�_/ <br /> Report To Bill ULTRAMAR INC <br /> 525 West Third Street <br /> r2✓��f Hanford, CA 93230 <br /> Attention i --� -- <br /> erR )C 9/, 7 -,5�39—Z-1 72— <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />