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ultramionc. BEAC•IR <br /> CHAIN OF CUSTODY REPORT <br /> Umminar <br /> Sampler Print Name D to Farm No. <br /> neacon Station No. p } ANALYSES 3+ r� 3 of 3 <br /> Project No. Sampler <br /> Project Location Affiliation 4 N c <br /> w, K M <br /> Date Time Lab Na, m �- --1. p z REMARKS <br /> A7f . Sample No./Identification — <br /> lr <br /> ( v 2- L?L3 L94 <br /> co- 4-o <br /> 5-0 <br /> i <br /> Date Time Re a c�` igrM r Ifliati Dale Tune <br /> Relinquished b : (Signature/Affiliation) - <br /> _ ate Time <br /> fielin wish by: 8i p l 1' Dat T <br /> ` <br /> ime .Recei d 1g ure/Af <br /> r- f <br /> R ' q b . S1 natur I io ) Dale Time Receiver! by: (Signature/Affiliation) <br /> Dale Time <br /> 4a <br /> Report To: e w �0%Vtw,,,�,- Dill#o: ULTRAMAR INC. <br /> 1f Laa 525 West Third Street <br /> 393n �a/' r Hanford, CA 93230 <br /> Attention:��"►r- �t <br /> Copy <br /> wj HIT, Rphirn In Client with Rennrt YFI I.OW: Laboratory Cony PINK: Originator <br />