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66w 6A 9" <br /> iEAft <br /> CHAIN OF CUSTODY REPORT - <br /> unranw " <br /> Beacon Station No Sampler(Print Name) Date Frm No <br /> ANALYSES 3 8"1- of .2 <br /> N <br /> Project No Sampler(Signature) "'! Ul , <br /> ' 'MD <br /> #`�vvv►n�1 �vrhstit�ul^�� <br /> Project Location f AffiliationQ o 0 c <br /> r a? <br /> o <br /> w _ _ �' <br /> Sample NoAdentification Date Time Lab No. m � � E— w z REMARKS <br /> Jany' ik Z) F4-"-L L-1' 1,23 I <br /> I - <br /> <A - <br /> r <br /> I L Lf 0 <br /> .10j n 1A <br /> Relinquished by'}(Siccinature/Affiliation) Date Time Received by (Signature/Affiliation) I Date Time <br /> Relinquished by (Signature/Affiltation) ate Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Dale Time Received by (Signal►jr ! filiatt n ate Time <br />$, Report Tof Bill to 1 ULTRAMAR INC <br /> r -�..3 !J��f' v, in`, 525 West Third Street <br /> N,,kta� j �,� Ic r 15u� �, 11�tin Hanford, CA 93230 <br />� Attention � y e�nr�� ��v� <br /> L ( ' ;J- 75 70 <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy '280079D <br />