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dhtra&r Inc. <br /> MOON <br /> CHAIN OF CUSTODY REPORT <br /> Ulm <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> 7 94ANALYSES -3-Y 9 of <br /> u`Jl%/ate ,P�1,� J,-� <br /> Project No. Sampler(Signature) <br /> 9�5 /0 ! L <br /> Project Location Affiliation -- <br /> SfG�.(c fon G /y►'/ i� G ° <br /> w = _ ° Starar'v1 T/9T <br /> Sam le No./Identification Date Time Lab No. m z I REMARKS <br /> I H <br /> i <br /> --ff I <br /> Relinquished by: (Signature/Aff'iation) Date Time Received b : Si nature/Affiliation <br /> Y ( 9 ) Date Time <br /> •,�,,, f�i7l��„� '-3� X117 ��-i��a � ��Y )1:l�' <br /> Relinquished by: (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 To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> V nc Hanford, CA 93230 <br /> Z Attention: ff, 45R <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINI(: Originator Copy �zaooa„au <br />