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Unramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Uma�nar <br /> Beacon Station No. Sampler(Print Name) Form No. <br /> ANALYSES S ! f of <br /> '09 11te 4/��,��s <br /> Project No. Sampl (Signature) <br /> , `.�' ' • °' Yom` <br /> Project Location Affiliation G `� <br /> a <br /> 3,y-/S C.cs—�!A»,11Qic�vv� ° �' 0 lS1Y'W <br /> 1 CD <br /> CcC�nl S /7 ovv�n-1Jnl v�i;'v�JA7- 1 T�� x o <br /> Ll ru = 1: <br /> Sample No./Identification Date Time Lab No. F� Z REMARKS <br /> 14 <br /> 7! — <br /> w s" � o �� J v <br /> "tet CU S �3 n 'I/,' e - <br /> Relinquished b : Signature/Affilialion) Date Time Received by: (Signature/Aftilialion) Date Time <br /> a� <br /> Relinquished 16y, <br /> ignaturelAtliliation} Date Time Received by: (Signature/Affiliation) Date Time <br /> 914e <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> ReportTo. <br /> ( Bill to: ULTRAMAR INC. <br /> i G.�r y .t3.Q rX .rt� <br /> 525 West Third ree <br /> Hanford, CA 930 Attention: J VW' <br /> 32 8003 ipso <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy <br />