Laserfiche WebLink
,= Ultramar Inc. BEACON <br /> r CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES 16-8-9 5 of <br /> Project No / Sampler(Signature) <br /> q_7 el . ( Cv a) c �Orn"a <br /> Project Location Affiliation c <br /> M <br /> Zpr�J Yi.'�t�rJei- I o <br /> 0 <br /> Sample No/ldentificaiion Date Time Lab No ~ °' a REMARKS <br /> W- icr - M w- V x <br /> V') , roN - r'l - 3 <br /> W -fbd - mw - r- <br /> l0r*1 - M r✓- S o-/l-qs <br /> - 1 FR <br /> -STLL = <br /> I <br /> Relinquished by Signature/Affiliation) Date Time Received by nat ton Date Time <br /> Relinquis ( turDal ' Af <br /> Date Time Received <br /> a e Time <br /> lr / <br /> Reli u s b ignature/Af i i ion} Date Time Received by (Signa dra <br /> g Time <br /> Report To Bill to U 1C_ <br /> 525 West Third Street <br /> /yFy Hanford, CA 93230 6)-9;9 a �7 a Attention n e f — ✓�7c , <br /> " Hl eturn to Client with Report YELLOW Laboratory Copy PINK Onginator Copy <br />