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M = M <br /> Vara r nc. MAIN <br /> unarm <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date form No <br /> C ANALYSES � , t�- ti of <br /> qI -f G Jrue- Lit "r / <br /> Project No Sampler(Signature) <br /> Project Locationk_ f Affiliation o <br /> \ <br /> ! ! Mll Cum x M 9? _ 0 TAT <br /> LU � <br /> Sample No/Identification Date Time Lab No m �- z REMARKS <br /> TZ f <br /> T4 <br /> S l <br /> i ( <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> f l t � I <br /> Relinquished by (Signat riEAffiliation) Date Time Received by (Signat, re/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> //--{ llxl3el 525 West Third Street <br /> �MtJ Hanford, CA 93230 ; <br /> Attention t J r 4y? <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINI( Originator Copy 320003190 <br />