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�:: ultranoinc. BEA <br /> CHAIN OF CUSTODY REPORT <br /> uniranmw <br /> Beacon Station No. Sampler(Print Name) D 7218z") <br /> Form No. <br /> / }} • --- ANALYSES of <br /> Project No. Sampler(Signature) 5t <br /> Project Location Affiliation �, J <br /> 1 <br /> LocC .tom 21? c°a �`�11G'��, ;gh� i11✓I� <br /> win= o (� X� M li.f3��)�f. <br /> Sample NoAdenlification Date Time Lab No. m F- j z REMARKS <br /> PL - ZA 1160 <br /> FL- SA 111219 V I/O a X ix If <br /> �P-. SA 111ZA 1145- <br /> X 1 <br /> V?ag X, <br /> x x t t)vL4L <br /> sP � lrlq • 111 A X, A I1 <br /> Relinquished bi ignaturelAffiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinq ishe :r5gna ure/ lilialion) Date Time Received by: (SignaturelAffiliation) Dale Time <br /> Relinquished by Signature) Ililial'o } Date Time Received by: al (filiation) to Time <br /> < <br /> Report To: y + I Bill to: ULTRAMAR INC. <br /> t� titbf e��an�,�,e 525 West Third Street <br /> Hanford, CA 9323D. <br /> 2 o S ��K $3$ S Attention: <br /> WI LITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32.9003 iM <br />