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u c <br /> . BEAAAMN <br /> CHAIN OF CUSTODY REPORT <br /> Wlrarr�ar <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> r ANALYSES f e . J , i of <br /> Project No. Sampler(Signature) <br /> Lo <br /> CD <br /> � <br /> Project Location Affiliation ' <br /> US U) <br /> T AT <br /> C_ <br /> O <br /> Sample NoAdentification Date Time Lab No m li' z REMARKS <br /> 1 � ( <br /> t <br /> c> <br /> i' <br /> Relinquished by (Signature/Affiliation) Date Time Received y (Si nat r t Date Time <br /> 'AV ++ > <br /> -/ '/1W -7U) <br /> Relinquished by (Signature/Affiliation) Date Time R�eivo by ( ature Aft inti Date Time <br /> I <br /> Relinquished by (SignaturelAffiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To ` Bill to ULTRAMAR INC t <br /> { 525 West Third Street <br /> Hanford, CA 93230 f ( <br /> Attention 1{ 11 . �► <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32 119031OW <br />