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uitran4binc. BEACO <br /> CHAIN OF CUSTODY REPORT <br /> unramar <br /> } �. <br /> Beacon Station No Sampler(Print Name) Date Form Np <br /> I /-/'I <br /> If- ANALYSES L-/4 "�?L 1 ofI' 4 S e n <br /> Project No Sampler(Signature) 5 <br /> UJTO � 03 <br /> Project Location ,,1e-S E, Fn V Affiliation <br /> w �- <br /> W _=a. o <br /> Sample No/Identification Date Time Lab No m ►�- z REMARKS <br /> vJ, 14 <br /> MW 5 <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signatb?e/Aff,liaho Date Time <br /> Relinquished by (Signature/Affiliation) Date Time e,ved by (S,gnat rel illation) Dae Time <br /> Rel,n , na ure/Affiliation Date Time Received bY`� 9 ) e ed by (SignaturelAffifiabon) Date Time <br /> Re ort Bill to ULTRAMAR INC <br /> L��JSGn 525 West Third Street <br /> H.1 j <br /> k Hanford, CA 93234 <br /> Attention 0, <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINI( Originator Copy 3280033/50 <br />