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lilt^ar Inc. B ©N <br /> CHAIN OF CUSTODY REPORT <br /> lifran�ar <br /> i <br /> Beacon Station No: Sampler(Print Name) Date Form No. <br /> C {1 I I ANALYSES C 1� `� of <br /> tU i f ,�: c_� N �La�V? <br /> Project No. Sampler(Signata e) <br /> Project Localion AffiliatiU3 77, <br /> gr�j�, <br /> w MM ° <br /> Sample NoAdentification Date Time Lab No. m � z REMARKS <br /> XX I <br /> V� L"-) - 513 AC) <br /> 514 AC <br /> 515 ACS <br /> Relinquished by: (Signatur /Affiliation) DateTime Received by: {Signature/Af#iliation) p�fe Time <br /> Ll <br /> C'. 3- ChftanCi LULW+ <br /> Relinqui . (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Report Ta `5HE1 L6 'Z,cltbj�-LS '144 7BZ- ZII U Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> y x 7fi&:- '7h.5r1 Hanford, CA 93230 <br /> Attention: KC it1A�E_j N LIYZA ;S_7_ <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy iW <br />