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r ultra(rar Inc. BES 016. <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date Form No <br /> ANALYSES of r <br /> Yo! <br /> /Vri 7S C n <br /> o Prect No.. Sampler(Signature) <br /> rki5 .1 P <br /> R, .f/�• f1 rn J���y /y/,� <br /> sr { Proiect Location &A Affiliation VV <br /> 4w' 111.^:1 x <br /> as <br /> LU <br /> CL <br /> t Sam to Noildentification Date Time Lab No. m z° REMARKS <br /> r et t 1 <br /> Relinquished by: (Signature/Affiliation) Date Time Receivedy: (S' aiuJa/Aff'li i6n) Date Time r� <br /> � f <br /> �,-x.11 .c-�.H�. �.��t � .�� t:+�•� ��..,_.�. � . j�� ��, , <br /> Relinquis ed by:(Signature/Affiliation) Date Time Received by:(Signature//iffiliatiort}' Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Report To: X {a i, Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> - _ .. Hanford, CA 93230 <br /> IlT/WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy U-8003 IM <br />