Laserfiche WebLink
Ultramar Inc. BEACON <br /> ue�ramar <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) D to Form No <br /> ZZ ANALYSES G of � <br /> Ve f�6� S <br /> Prosect No Sampler(Signature <br /> Project Location Afiili tion � <br /> a35O4c�CcoG <br /> �ac,�'� M T c0 /c���JA�fo�rrQ <br /> GO 1,11?QrQA7t V9 z 401C <br /> w = = <br /> Sam le NoAdentification Date Time Lab No m Q z°I REMARKS <br /> - 0q <br /> .000 575- <br /> lip Cis L112 Septi 3 <br /> 0''' <br /> I-K- 5 <br /> Relmqu shed by (§ignature/Affiliation) Date Time Received by (Signature/Affiliation) - Date Time <br /> Ylft 114 <br /> Relinquished bylQnature/Affiliati—oir Date Time Received by (Signature/Affiliation) f - Date Time <br /> .f",6� tam #§e 1`f <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> )1114,4k <br /> Report To e",q zy 4S,41<01 Bill to ULTRAMAR INC <br /> ICVV►I/O?Gl1,716-�4 )AIC, 525 West Third Slree r <br /> >1 `� 1114J2,4 19c�ekiyr� y S v rf�� Hanford, CA 93230 <br /> t F< an^,q) ,Oa-5 �CA Attention3T- <br /> 1 <br /> WIW Return to Client with Report YELLOW Laboratory Cop PINK Originator Copy <br />