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0 . <br /> urn'a�nsr�r>rc. M1V EACiN <br /> CHAIN OF CUSTODY REPORT <br /> Bexon Station No. Sampler(PdM Name) Date Form No. <br /> ANALYSES -A-� of " <br /> Project No. Sampler(Signature) A 4�-4 <br /> Ig 4 1 <br /> Project Location Ailifiation <br /> MM O <br /> SamNo.11dentlRcation Dale Time Lab No. <br /> Q. z REMARKS <br /> ILI <br /> Relinquished by,(Signa(urelAffJWon) Date Time Rece' •(S' A4f' on) Date Tim <br /> q 48a ell <br /> Regi .(S' WAffln) <br /> Date Time �ved#fir:(SignaturnlAff;ila D Time � <br /> elfnquisheciby:(SigrraQate Time Received by:(ftrWureJAffiliation) Date Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> A AU Hanford.CA 83230 <br /> .31- ?S7a Attention: <br /> WHITE Retum to Client with Report YELLOW.Laboratory Copy PINK:Originator Copy <br />