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uwa r Inc. SISAM N <br /> CHAIN OF CUSTODY REPORT V 7 7 / <br /> I <br /> Beacon Station No. Sampfe (Print Name Date f=or No. <br /> �74 ' ANALYSES l� of <br /> Project No. ler(Sig re) <br /> . 121 L z <br /> Project Location i iat' <br /> 5�7e4 4;�'7 <br /> o <br /> Sa fe NoAdentification Date Time Lab No. °IZI REMARKS <br /> L�7 ;dp <br /> e. <br /> Re'squish :(Signator (filiation) Date Time Received by:(Signature/Affiliatfo ) Date Time <br /> efin s by: ature/Affrliation) a Time eceiv y:(Signature/Affili ton) a Time <br /> i <br /> Relinquished by:(Signature/Affiliatfv ) Date Time eived by: (Signature/Affiliation) Date Time <br /> i <br /> 30 <br /> Report.To: Bill • ULTRAMAR INC. <br /> Q y y NOV' 525 West Third Street <br /> / Hanford, CA 93,230 <br /> 7 ,7� Attention: !' W-4�5� <br /> WHI E: Return to Client With eport �--YELLOW:Laboratory Copy PINK:Originator Copy 3240031/90 <br /> L <br />