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UnAar Inc. BEAN <br /> CHAIN OF CUSTODY REPORT h f 6'13 <br /> uue�rrnr <br /> 1� <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> / �L i� ANkYSES -coo of <br /> Project No Samplertg o <br /> La <br /> Project Location Affilialion c = <br /> m <br /> ©Ci, D N <br /> fo c fi-arr� s• X 04� Q <br /> 0 <br /> Sample NoAdentilication Date Time Lab No m z REMARKS <br /> -� Mw - l 3 - 1 -00 �' = <br /> 3Z' <br /> L� <br /> fits — 00 `cf Z <br /> ,�- ,A4 u- - • 2 �y <br /> - � mow - �• s �-v1III h <br /> 4 <br /> - v( Al H <br /> -- Gl-7 <br /> y' v V✓ r r0 fi C1 <br /> Relinquis (S n u /Affiliation) Date Time Rece�by (SignaturelA I!Ha Date Time <br /> '40vz �S <br /> Rei �s S naturelAffiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> ------- <br /> Relinquished by (Signature/Affiliation) Date Time Received by (SignaturelAffihatcon) Date Time <br /> I 4elw <br /> A/ <br /> Report To Bill to ULTRAMAR INC <br /> J 525 West Third S reet <br /> Hanford, CA 93230 ��� <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />