Laserfiche WebLink
t• Lrr �r ncm = = = " i� <br /> BE N <br /> CHAIN OF CUSTODY REPORT <br /> umamar '�: <br /> Beacon Station No Sampler(Print Name) Date Form NO r <br /> j ` ! ANALYSESc - ► 3 � of 5 <br /> Protect No Sampler(Signature) ' <br /> Project Location Afft6ation m <br /> cu ` <br /> 1r V, 0 0 <br /> N W Q a <br /> L <br /> _ X D1' 46 <br /> uJ 2 2 <br /> Sample Noildentification Date Time Lab No m z° REMARKS <br /> f C Gtr NO <br /> r <br /> Y <br /> 1 <br /> i � 3 <br /> Relinquished by (Signature/Affiliation) Date Time Received ida r90A la 10n) Date T�me� <br /> Relir4uished by (Signature/Affiliation) Date Time Received y ignatu a ffiJE ion) Date Time <br /> f <br /> aF <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 /> 10 <br /> Hanford, CA 93230 +` <br /> Attention <br /> + - WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32 GM3190 <br />