Laserfiche WebLink
Ulframar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT / + <br /> Beacon Station No, Sampler(Print Name) Date Form No. <br /> l ? 17 nI f (' ANALYSES <br /> Project No. Sampler(Signature) <br /> 71 <br /> Project Location Affiliation -- <br /> /..,,��, r .o c <br /> ( ti'cmjz <br /> O <br /> W <br /> Sample Noildentification Date Time Lab No. CL z REMARKS <br /> Reli quished by: (Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> elinquisl by:(Signature/Affiliation) Date Time Received by: Si nature/Affiliation <br /> Y ( 9 ) Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time Received by: S' nature/Affiliation <br /> Y ( '9 ) Date Time <br /> Report To: / Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention: - •� C.3�,�� <br /> J <br /> WHITE: Return to CliI ent with Report YELLOW: Laboratory Copy PINK:Originator Copy 32-590 IM <br /> I <br />