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uitr&Wr Inc. BEANM <br /> CHAIN OF CUSTODY REPORT <br /> unramwW <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES z of <br /> J. r <br /> Project No. Sampler(.51gRoture) <br /> Project Location <br /> 75 <br /> 0 0 <br /> MRD <br /> X -- <br /> CM 100 <br /> LU M x <br /> a rJ 'I <br /> 6 <br /> - a. "I � <br /> Sample NoAd:enlification Date Time Lab No. z REMARKS <br /> Gi <br /> 2- <br /> /7) J-q <br /> Relinquished by: (SighaturetAffiliation) Date Time Received by: (SignaturetAff iliation) Date Time <br /> /-z <br /> Relinquished by: (Sig nature/Affiliation)- _Date Time Received by: (Signahkreffiff iliation). Date Time. <br /> : <br /> Relinquished by: (Sigp%pre/Af@iation) Date Time Received by (SigWA ate <br /> Time <br /> Bill to: <br /> Report To: ULTRAMAR <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention: <br /> WHITE: Return.to Client withYELLOW: Laboratory Copy PINK: Originator Copy 32-a=I M <br />