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ulf ar Inc.OF �! 0'Z BE*N <br /> CHAIN C C1STODY REPORT �y .� <br /> Beacon Station No Sampler(Print Name) ao Date Form No <br /> ` ANALYSES 1 Z- of <br /> Project No Sampler(Signature) <br /> Affiliation <br /> Project Location - E <br /> on V) r- o <br /> Cd T <br /> I x cnv V o <br /> W 2 2 V <br /> Sample No/Identification Date Time Lab No a~oCL z° REMARKS <br /> fCr <br /> Relinquished y (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Dale <br /> Time <br /> 17 <br /> Relrnquis ed by (Signature/AffiliatIon) Date Time Received by (Sign ture/Af ration) Date Time <br /> Ta' <br /> Relinquished by (Signature/Affilialion) Date Time Received by (Signature/Affiliation) Date Time <br /> I <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> J; Z U►-� 1 J`� { Hanford, CA 93230 <br /> 1',4e Attention AL1nJoc,-- <br /> WHITE <br /> Return to Client with Report YELLOW Laboratory Copy PINK OngmatorCopy 320003 <br />