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a+ Ultra& Inc. BEACI <br /> - CHAIN OF CUSTODY REPORT <br /> Lftn nnar <br /> Beacon Station No Sampler(Print Name) D e Form No :7 ANALYSI=S � G��'� of <br /> Project No SampI (Signature S'A,vOfi,41� <br /> (D a <br /> Project Location <br /> Affiliationo � caN�Dui <br /> a 35U 1taQ�od �?a U <br /> ra TU <br /> X R <br /> F- aaa.. � o <br /> Sample Noildentification Date Time Lab No 1`- 1-- z REMARKS <br /> W5- q5' Ar "/V/" 1 61? kf t <br /> S - to)zoS - J ) 3 Ob M aVVJ <br /> VV3 .35I'm <br /> • s - �v "� Cgs ,' Ssr��-r� r 3 ! l <br /> • S- �nwS- �� S;a��r, � <br /> Rl_0.U-:VE:D <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) a ly"- Date Time <br /> ' l ' o - -- ''� �/,� <br /> "RelinquishSignature/Affi ion) Date Time Received by (Signature/Affiliation) � ', o ! l ,_,w -Date Time <br /> /�015ti jV - _ <br /> Relinquished by (Signalure/Affiliation) Dale Time Received by (Signature/Affiliation) Date Time <br /> Q�a-V-4 P11z.4– <br /> d4 <br /> Report To C.4n,,V AizKM Bill to ULTRAMAR INC <br /> /41C. 525 West Thtrd Si <br /> C)Go,-Zo// GpvEN laf,-H [z ARe4tr4SU� <br /> }' 1 Hanford, CA93 30 <br /> EL a'/Ae;V /4"'.c5� 09 Attention ,-vlgzl- <br /> S/E�����4,r►f <br /> WHITE Return 10 Client with Report YELLOW Laboratory Copy PINK Originator Copy 925007/90 <br />