Laserfiche WebLink
17 l <br /> --0 Ummmar bc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) e Form No. <br /> D ! <br /> I ANALYSES D Of 1 � <br /> Project No. SampleMA' n tore <br /> o ( - / <br /> C <br /> Project Location Affilia n r r l Q N <br /> PF <br /> x `r= o <br /> ix <br /> Sa a NoAderdification Date Time Lab No. fn 01 REMARKS <br /> -s -• Z �� J ,56 1 ! � <br /> 5,3 _ 171x" <br /> Relingvis a/Afliliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> i <br /> y i <br /> Relinquished by:(Sign a2t re/Aifiliatio ale I ime ;ece' ed by:(Signature/Affjliavon) i v Date Time <br /> Reli6q66KecTby' (Sigh-aluffiliation) J Date Time ExecOved by:(Signature[Affiliation) Date Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> r <br /> ` iii e� �C.t{fc' r�. Hanford,C.19320 � <br /> Attention: (,2/L3;0 <br /> , <br /> WHITE Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy �� �° <br />