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111rarInc. RECEIVEr� <br /> 1!) <br /> , J BEACOM <br /> ixtranw CHAIN OF CUSTODY REPORT DEC Q 2 1991 <br /> Z <br /> Beacon Station No Sampler(Print Name) fir4, "" Da Form No <br /> ANALYSES �� z`y l y of <br /> Prole ct No �r Sam er(Signature) <br /> e Tr I - PC 4r,I lei <br /> JI <br /> Affiliation Location E <br /> � � U <br /> Aegis Environmental cc <br /> WT = <br /> Sample No/identification Date Time Lab No c r z REMARKS <br /> 31 <br /> 1 311/ <br /> 3H ly !�LL <br /> Rellpquished by (Signature/Affiliation) Date Time Rece by (Signature/Affiliation) Date Time <br /> elm ish'by (Si nature/Affiliation) Date Time Rec ved b ignature/ diation) Date 1 ime <br /> II <br /> I �tY fly Y�� <br /> i�� <br /> ,ed by (l ign�rbllldiation) ate Time Received by (S ature/Affiliation) ,t Pate Tim <br /> rI <br /> Report To Bill to ULTRAMAR INC <br /> Sheila Richgels 525 West Third Street <br /> Aegis Environmental Hanford, CA 93230 <br /> 1050 Melody Lane, Suite 160 Attention <br /> !' 1 <br /> Roseville CA 95678 <br /> WHITE Return to Client with Report __ YELLOW Laboratory Copy PINK Originator Copy 32 B003190 <br />