Laserfiche WebLink
MUlflnc. BEA N <br /> CHAIN OF CUSTODY REPORT , <br /> erm <br /> Gunronm <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> j ANALYSES ,a •2 z-9 3 of <br /> Protect No Sampler(Signature) <br /> 1 141J 63 ' <br /> ' Protect 3as'�n o Affiliation N Q 12 <br /> U <br /> r It, # C � M�] C�2.� X 010 ,. <br /> O <br /> ULI XXf <br /> Sample Nolldentification Date Time Lab No m z° REMARKS <br /> <> 65 � y <br /> (z5- z-0 ' <br /> Relinquished by (Si naturetAffiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> �j <br /> Y� <br /> Relinquished by (Si nature/Affiliation) Date Time Receied by (Signa ure/Affdiation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> r Hanford, CA 93230 <br /> A M LJ Attention !. • h1g ��,�I�-+ :C� t <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINI( Originator Copy 1280D3/90 <br />