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0 0 <br /> Unramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date f=orm No <br /> ANALYSES "- `-`'^ 2—of <br /> Project No Sampler(Signature) <br /> Project Location Affiliation �, m <br /> N O <br /> W = _ <br /> Sample Noildentification Date Time Lab No m z° REMARKS <br /> r <br /> V1 77 <br /> 13 <br /> c� <br /> / I <br /> 0 <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> 13- <br /> ffe—1i n-quby (Signature/Affiliation) Date Time Rece by (Signa re/Affiliation) Date Time <br /> � �✓�� 1 36q 1Q�� <br /> Relinq shed by (Sig ature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Q� aA- �?bOd /f9b <br /> Report To Bill to ULTRAMAR INC <br /> r; t r 525 West Third S eet <br /> Hanford, CA 9323f} <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy �067 90 <br />