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_.N+w.r.wt R�'.�AM..wrr. '+-.w,R .[.v .s•..Inc. <br /> ..nc. GON <br /> CHAIN OF CUSTODY REPORT <br /> Beaoon Station No. Sampler(P ame) Date u Form No. <br /> �" 1tJl 1j/� ANALYSES (�-2L- of <br /> l �� s � <br /> t Sampler(Si ure) <br /> Project 1Vo. � v <br /> `� n � <br /> f L/7 L <br /> Project Location Affiliation <br /> r o � <br /> t.. .., <br /> Sa NoJtdentincation Date Time Lab No. z REMARKS <br /> —aGZG�- �Iw (, -Z6-,k> IZ ;vo IXI <br /> 1od.- 0 116 /ti <br /> --OL 'Z r',J 5- <br /> = oU Zb Mena <br /> /, 3v <br /> �..� v <br /> •t,5'i.{awn J <br /> Relinquish y:(Signature/Atfiliati ) Date Time Received by:(Signature/Affiliation) Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Date Time Received by: (Signature/Affiliation) Date Time <br /> • Relinquished by:{Signature/Affiliation) ,• . <br /> Report.To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street J <br /> Hanford, CA 93230 �� Ok I C !� <br /> !LI KI Attention: <br /> WHITE: Retum to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br />