Laserfiche WebLink
ultr*ar Inc. <br /> BEACON <br /> llltramer <br /> CHAIN OF CUSTODY REPORT ° <br /> Beacon Station No Sampler(Print Name) DateForm No <br /> ANALYSES 5 — �c &a of <br /> Project No Sam p r(,Signature) <br /> Project Location Affiliation <br /> II, CD <br /> K PU -V �Or'r C�tet/ x yr 9? , U <br /> w = = o <br /> a. <br /> Sample NoMentihcation Date Time Lab No m ►a— z REMARKS <br /> v <br /> 1 <br /> D Q <br /> yo -,&I w 05� ill -1 <br /> Relin shed by (Signature/Aff tion) Date Time Received by (Signature/Affiliation) Date Time <br /> C�'� 2C,i S� . Nk� �f� O(C�-� I 90 -VOt <br /> Reli*ished p(51gnature/Affili ion) Date Time Received by (Signature/Affiliation) b° Date Time <br /> ;///l 13 2� <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> _In lvkv�' l3' <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third ree <br /> A r r'2 .� Hanford, CA 93230- <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32 BD03 IM <br />