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Mir M M M M M M me! M M, <br /> Ultramar Inc. BAC�H <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station N. Sampler(Print Name) We Form No. <br /> ANALYSES -1-6-93 <br /> Proms No. Sampler(Signature) <br /> � to <br /> Project Location Affiliation <br /> Z l$y E•�r �f 5.4, 4z-A 61, CA r. t w Lp c i <br /> SSG Oi <br /> y <br /> _ �. a <br /> Sa le NoerttiFfcatiart Date Time Lab No. a. .Q ° REMARKS <br /> !.ttc,.Aw.Lu oak <br /> I I <br /> (.e C -JL L .i` <br /> J- I <br /> a� <br /> I <br /> i <br /> I <br /> i <br /> by W.ES.T. <br /> lVe dada <br /> RelinquisFred by:(SignaturelAfiCaliatinn) Date Time Received by:(Signature/Affiliation) Date Time <br /> 7-1-1) D`i'll <br /> Relvx0shed by:{Sign urWAf(jiation) Date Time Received by:(Sig naturelAffi iatlon) I Date Time <br /> I <br /> Relinquished by:(Sigrlature/Affr7iation} Date Time R e' (Stt�fe D to Timeti <br /> Report To: <br /> • .,_�. �.�. t , o: l <br /> Gly -�c�l [}�,..�ui.• 25 Vest Third Street <br /> 5,Dtj K.S "-.1A.z—j-; d��7 X9 Hanford,CA 903230 <br /> Attention: l4.�.�: r-�• <br /> WHITE:Aetum to Client with Report YELLOW:Laboralory Copy PINK;Originator Copy <br />