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( R r�_ �� i <br /> ..� AV I � �Jltra�tr Inc. BEAAN ` <br /> CHAIN OF CUSTODY REPORT <br /> munra (` Ito) ?_5 3 -`I f 5CUC <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> 9 ANALYSES `I - of <br /> Project No Sam r(Signature) <br /> NT ,7 <br /> Project Location Aff S /41 -K�6IOA)4L <br /> `170 tiJ MAW 5r. _ oca <br /> MAKIrEC- L J5 �gI(2VAJ G: A)rJL X � M &cTi5-6rIeW �miT5 <br /> w = = o <br /> Sample No/identification Date Time Lab No m � rat z REMARKS <br /> Mit') / N - 6 93 X � I 11 3 <br /> rnty - z s o1 31 <br /> 2 <br /> Relinqu lied by (Signature/Affiliation Date Time Receiv by/($ignature/Affiliation) / Date Time <br /> qlpz <br /> Relinquished by (Signature/Affiliation) Date Time R Fved by (Signature/Affiliation) ` Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) _ _ _ _ Date Time <br /> Report To ,elU1C�t(.S (`ll&) 7 t-2110 Bill to ULTRAMAR INC <br /> 525 West Third Street -AIN 9 1-9E J QjVC`-,— <br /> r-.V -At 7&, 7E } Hanford, CA 93230 <br /> j5 L� e1�,721� Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 328003,M <br />